Ergotamine (Ergomar) acts on the smooth muscles of the blood vessels and uterine muscles. It is used in the treatment and prevention of migraine. The drug has been associated with serious cardiovascular adverse events and should be avoided in patients with hypertension, angina, and those with risk factors for ischemia.

Ergotamine Uses:

• Vascular headache:

  • It is used in the prevention and acute abortive treatment of vascular headaches such as migraine headaches, migraine variant headaches, and histaminic cephalgia.

Ergotamine (Ergomar) Dose in Adults

Ergotamine (Ergomar) Dose in the treatment of Vascular headache:

• Sublingual:
  • It is administered as one tablet (2 mg) under the tongue as soon as the patient senses a sign of a migraine,
  • The dose may be repeated in a dose of 2 mg every 30 minutes if required to a maximum dose of 6 mg per day and a total of 10 mg per week

Ergotamine (Ergomar) Dose in Childrens

Ergotamine (Ergomar) Dose in the treatment of Vascular headache:

• Adolescents:

  • Sublingual:
    • It is administered as 2 mg (one tablet) under the tongue as soon as the patient senses the first sign of a migraine.
    • The dose may then be repeated in a dose of 2 mg (one tablet) every 30 minutes as tolerated and if required.
    • The maximum dose per day should not exceed 6 mg and the maximum dose per week should not exceed 10 mg.

Note:

• It is important to note that newer antimigraine medicines are more commonly used because of better efficacy and fewer adverse effects.
• Newer antimigraine medicines used to abort the migraine attack include:
  • Sumatriptan
  • Zolmitriptan
  • Rizatriptan
  • Naratriptan
  • Almotriptan
  • Ajovy (Fremanezumab)

Pregnancy Risk Factor X

• It results in decreased placental blood flow by causing smooth muscle contractions in the uterine blood vessels and myometrium.
• A reduced blood supply to the foetus can cause fetal growth retardation.

Use of ergotamine while breastfeeding

• Breastmilk may contain the drug.
• This can cause vomiting, diarrhea, weaken pulse, and changes in blood pressure in the infant who is being fed.
• Sometimes, nursing or treatment may have to be stopped.

Dose in Kidney Disease:

It should be avoided in patients with impaired renal function.

Dose in Liver disease:

It is not indicated in patients with liver disease.

Side effects of Ergotamine (Ergomar):

• Cardiovascular:

  • Bradycardia
  • Cold Extremities
  • ECG Changes
  • Edema
  • Hypertension
  • Ischemia
  • Tachycardia
  • Valvular Sclerosis
  • Vasospasm

• Central Nervous System:

  • Numbness
  • Paresthesia
  • Precordial Pain
  • Vertigo

• Dermatologic:

  • Gangrene Of Skin Or Other Tissue
  • Pruritus

• Gastrointestinal:

  • Nausea
  • Vomiting

• Genitourinary:

  • Retroperitoneal Fibrosis

• Neuromuscular & Skeletal:

  • Myalgia
  • Weakness

• Respiratory:

  • Cyanosis
  • Pleuropulmonary Fibrosis

Contraindications to Ergotamine (Ergomar):

• Allergy to any drug or component of the formulation
• Peripheral Vascular Disease
• Liver and kidney disease
• Coronary artery disease
• Hypertension
• Sepsis
• Use with strong inhibitors of CYP3A4 such as protease inhibitors and azole antifungals along with some macrolide antibiotics
• Pregnancy

Warnings and precautions

• Cardiac Valvular Fibrosis:

  • The rare association with fibrotic thickening of the aortic, mitral and tricuspid valves has been found to be caused by prolonged use of ergotalkaloids.

• Cardiovascular effects

  • Ergot derivatives affect the smooth muscles in the blood vessels, causing vasoconstriction. This could lead to hypertension and a decrease in cerebral blood flow.
  • The drug can cause peripheral vasoconstriction, which could lead to angina, digital ischemia, ischemic collitis, myocardial injury, and ischemic colitis if it is used for a prolonged period.
  • Patients with vascular disease should be cautious about taking ergot alkaloids.
  • According to the American Heart Association (AHA), it is suspected of causing myocardial toxicemia (magnitude major).

• Ergotism:

  • Ergotamine and other alkaloids from ergot may cause severe vasoconstriction (ergotism), which may lead to peripheral vascular ischemia, which can cause gangrene in the distal parts like the fingers and toes.
  • Overdosage and prolonged use can lead to ergotism. Avoid overdosing or prolonged use of the drug.

• Retroperitoneal and pleural fibrosis

  • The drug can rarely be used for prolonged periods of time.

Ergotamine: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

• Monitor blood pressure, pulse, and ECG
• Monitor for the response to treatment.

How to administer Ergotamine (Ergomar)?

The tablets should not be crushed, broken, or chewed. It may be taken without regard to meals.

Mechanism of action of Ergotamine (Ergomar):

• It can act as an antagonist or partial agonist of alpha-adrenergic, tryptamine and dopamine receptors, depending on where they are located.
• It stimulates the contraction of the uterine muscles.
• It causes constriction in the cranial, peripheral blood vessels as well as the depression of central vasomotor systems.

Absorption:

• Absorption is erratic following oral or rectal administration.

Metabolism:

• It is metabolized extensively in the liver, including high first-pass metabolism.

Bioavailability:

• Oral, rectal: Less than 5%.

Half-life elimination:

• 2-2.5 hours.

Time to peak serum concentration after oral administration:

• 2 hours.

Excretion:

• Feces (90%), primarily excreted as metabolites.

International Brand Names of Ergotamine:

• Ergomar
• Antimigraine
• Avamigran
• Cafeton
• Caftar
• Clavigrenin akut
• Cornutamin
• Enxak
• Ergam
• ergo sanol
• Ergo-Kranit
• Ergocaf
• Ergodryl Mono
• Ergokapton
• Ergosanol
• Ergosanol SL
• Ergosanol Spezial N
• Ergotamin
• Ergotamin Medihaler
• Ergotamin ”Dak”
• Ergotamina tartrato
• Ergotaminum Tartaricum
• Ergotan
• Ergotartrat
• Gynergen
• Lingraine
• Medihaler Ergotamine
• Medihaler-Ergotamine
• Migranil
• Migretamine
• Migrexa
• RubieNex
• Secagyn
• Sydolil
• Tetralgin Haler
• Trinergot

Ergotamine Brands Names in Pakistan:

No Brands Available in Pakistan.