Ergotamine

Aka: Ergotamine, Wigraine

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II. Indications

  1. Migraine Abortive Management
    1. Rarely used in modern U.S. Migraine Management (largely replaced by Triptans)

III. Precautions

  1. Ergotamines have been replaced by Triptans for multiple reasons
    1. Low oral Bioavailability
    2. High risk for Medication Overuse Headache
    3. Common associated Nausea and Vomiting
    4. Serious adverse Drug Interaction risk

IV. Dosing

  1. Sublingual
    1. One tab SL
    2. Repeat in 1/2 hour prn
    3. Maximum: 3/day or 6/week
    4. Oral tablets available
  2. Rectal Suppository (Wigraine)
    1. One rectally at Headache onset
    2. May repeat hourly
    3. Maximum: 2 suppositories per day or 12 per month
    4. Limit no more than 2 days per week
    5. May use for Menstrual Migraine

V. Adverse Effects

  1. Nausea, Vomiting
    1. Use Antiemetic
  2. Rebound Headache
  3. Occluded vessel in Overdose
    1. Overdose levels
      1. Daily use exceeds 6 mg
      2. Weekly use exceeds 10 mg
    2. Potentiated by
      1. Beta Blockers
      2. Dopamine
      3. Fever
      4. Liver Disease

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