Ergotamine


Concise Prescribing Info
Indications/Uses
Migraine.
Dosage/Direction for Use
Adult : Sublingual As ergotamine tartrate: 2 mg on the onset of attack, then 2 mg every 30 min if necessary. Max: 6 mg/24 hr, 10 mg/wk. Inhalation As ergotamine tartrate: Inhale single dose (360 mcg) at the onset of attack and repeat at 5-min intervals, if necessary. Max: 6 inhalations/24 hr, 15 inhalations/wk.
Dosage Details
Inhalation/Respiratory
Migraine
Adult: As ergotamine tartrate: Inhale single dose (360 mcg) at the onset of attack and repeat at 5-min intervals, if necessary. Max: 6 inhalations/24 hr, 15 inhalations/wk.

Sublingual
Migraine
Adult: As ergotamine tartrate: 2 mg on the onset of attack, then 2 mg every 30 min if necessary. Max: 6 mg/24 hr, 10 mg/wk.
Renal Impairment
Contraindicated.
Hepatic Impairment
Contraindicated.
Administration
May be taken with or without food.
Contraindications
Patient w/ severe or uncontrolled HTN, severe or persistent sepsis, shock, peripheral vascular disease, temporal arteritis, ischaemic heart disease, hyperthyroidism; basilar or hemiplegic migraine. Renal or hepatic impairment. Pregnancy. Concomitant admin w/ potent CYP3A4 inhibitors (e.g. azole antifungals, protease inhibitors, macrolide antibiotics).
Special Precautions
Patient w/ anaemia. Lactation.
Adverse Reactions
Nausea and vomiting, abdominal pain, tingling of fingers and toes, weakness, muscle pains in the extremities and numbness, localised oedema, itching, bradycardia, transient tachycardia.
PO/Rectal/SL: X
Patient Counseling Information
May cause dizziness and feelings of anxiety, if affected, do not drive or operate machinery.
MonitoringParameters
Evaluate CV status prior to initiation and periodically thereafter.
Overdosage
Symptoms: Numbness, vomiting, tingling, pain, cyanosis of the extremities associated w/ diminished or absent peripheral pulses; HTN or hypotension; stupor, drowsiness, convulsions, shock, coma; reversible bilateral papillitis w/ ring scotomata. Management: Maintain adequate pulmonary ventilation, correction of hypotension and control or BP and convulsions. Keep the extremities warm to treat peripheral vasospasm. Vasodilators may be beneficial.
Drug Interactions
Increased risk of peripheral vasoconstriction w/ β-blockers. Increased vasoconstrictor effect w/ sympathomimetics (e.g. epinephrine).
Potentially Fatal: Increased risk of ergotism w/ potent CYP3A4 inhibitors (e.g. azole antifungals, protease inhibitors, macrolide antibiotics).
Food Interaction
May enhance toxicity w/ grapefruit juice.
Action
Description: Ergotamine has marked vasoconstrictor effects and partial agonistic action at serotonin (5-HT) receptors. It causes constriction of peripheral and cranial blood vessels and produces central vasomotor center depression. It also has a powerful oxytocic action on the uterus.
Pharmacokinetics:
Absorption: Poorly absorbed from the GI tract. Bioavailability: Approx ≤5%. Time to peak plasma concentration: 2 hr (oral).
Distribution: Crosses the blood-brain barrier; enters breast milk. Volume of distribution: 1.85 L/kg. Plasma protein binding: Approx 93-98%.
Metabolism: Undergoes extensive hepatic metabolism, including high first-pass effect.
Excretion: Via faeces (90%, mainly as metabolites); urine (approx 4%). Biphasic elimination half-life: Approx 2 hr (initial phase); 21 hr (terminal phase).
Chemical Structure

Chemical Structure Image
Ergotamine

Source: National Center for Biotechnology Information. PubChem Database. Ergotamine, CID=8223, https://pubchem.ncbi.nlm.nih.gov/compound/Ergotamine (accessed on Jan. 22, 2020)

Storage
Store between 20-25°C. Protect form heat and light.
ATC Classification
N02CA02 - ergotamine ; Belongs to the class of ergot alkaloids preparations. Used to relieve migraine.
References
Anon. Ergotamine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 20/01/2016.

Buckingham R (ed). Ergotamine Tartrate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 20/01/2016.

Ergomar Tablet, Orally Disintegrating (Rosedale Therapeutics). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 20/01/2016.

Joint Formulary Committee. Ergotamine Tartrate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 20/01/2016.

McEvoy GK, Snow EK, Miller J et al (eds). Ergotamine Tartrate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 20/01/2016.

Medihaler Ergotamine Aerosol, Metered (3M Riker). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 20/01/2016.

Disclaimer: This information is independently developed by MIMS based on Ergotamine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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