BMA Concise Guide to Medicine & Drugs

Ergotamine

Brand names None

Used in the following combined preparations Cafergot, Migril

QUICK REFERENCE

Drug group Drug for migraine

Overdose danger rating Medium

Dependence rating Medium

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Ergotamine is used to treat migraine attacks, but its use has largely been superseded by newer agents with fewer adverse effects. It may also be used in the prevention of cluster headaches. For migraine, it should be restricted to when other treatments are ineffective, and it should be taken only at the first sign of migraine (the “aura”); later use may be ineffective and cause stomach upset. Ergotamine causes temporary narrowing of blood vessels and, therefore should not be used by people with poor circulation. If taken too frequently, the drug can dangerously reduce circulation to the hands and feet; it should never be taken regularly. Frequent migraine attacks may indicate the need for a drug to prevent migraine.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, suppositories.

Frequency and timing of doses Once at the onset, repeated if needed after 30 minutes (tablets) up to the maximum dose.

Adult dosage range Varies according to product. Generally, 1–2mg per dose. Take no more than 4mg in 24 hours or 8mg in 1 week. Treatment should not be repeated within 4 days or more than twice a month.

Onset of effect 15–30 minutes.

Duration of action Up to 24 hours.

Diet advice Changes in diet are unlikely to affect the action of this drug, but certain foods may provoke migraine attacks in some people.

Storage Keep in original container at room temperature out of the reach of children. Protect from light.

Missed dose Regular doses of this drug are not necessary and may be dangerous. Take only when you have symptoms of migraine.

Stopping the drug Can be safely stopped as soon as you no longer need it.

Exceeding the dose An occasional unintentional extra dose is unlikely to cause problems. Large overdoses may cause vomiting, thirst, diarrhoea, dizziness, seizures, or coma. Notify your doctor immediately.

POSSIBLE ADVERSE EFFECTS

Digestive disturbances, abdominal pain, muscle cramps, and nausea and vomiting (for which an anti-emetic may be given) are common with ergotamine. Consult your doctor if any of these symptoms are severe or if you experience dizziness, muscle pain or stiffness, or severe diarrhoea. Cold or numb fingers and toes are rare but serious side effects that may result from arterial spasm. If these symptoms occur or if you experience chest pain, leg pain, or groin pain, stop taking the drug and seek immediate medical advice.

INTERACTIONS

Beta blockers These drugs may increase circulatory problems with ergotamine.

Sumatriptan and related drugs There is an increased risk of adverse effects on the blood circulation if ergotamine is used with these drugs.

Erythromycin and related antibiotics and antivirals taken with ergotamine increase the likelihood of adverse effects.

Oral contraceptives There is an increased risk of blood clotting in women taking these drugs with ergotamine.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have long-term liver or kidney problems.

· You have heart problems.

· You have poor circulation.

· You have high blood pressure.

· You have had a recent stroke.

· You have an overactive thyroid gland.

· You have anaemia.

· You are taking other medicines.

Pregnancy Not prescribed. Ergotamine can cause contractions of the uterus.

Breast-feeding Not recommended. The drug passes into the milk and may have adverse effects on the baby. It may also reduce your milk supply.

Infants and children Not usually prescribed.

Over 60 Not recommended. May aggravate existing heart or circulatory problems.

Driving and hazardous work Avoid such activities until you have learned how ergotamine affects you because the drug can cause dizziness.

Alcohol No special problems, but some spirits may provoke migraine in some people.

Surgery and general anaesthetics Notify your doctor if you have used ergotamine within 48 hours prior to surgery.

PROLONGED USE

Reduced circulation to the hands and feet may result if doses near to the maximum are taken for too long. The recommended dosage and length of treatment should not be exceeded. Rebound headache may occur if it is taken too frequently.