The drug ergotamine:
- is effective in no more than 50% of patients when given sublingually, rectally, or nasally.
- may require an anti-emetic to be prescribed with it.
- together with related compounds, should be given by the route that is acceptable to the patient, and doses should be increased to a single effective dose as early as possible in subsequent attacks
- contraindications:
- coronary artery disease } has vasoconstrictor
- peripheral vascular disease } actions and can cause ischaemia
- possible side effects include:
- nausea, vomiting, abdominal pain, diarrhoea, muscle cramps, limb paraesthesia, vasoconstriction
- now largely superseded by the use of 5HT1 agonists e.g. sumatriptan, because of unpredictable efficacy and tolerability in individual patients (1).
Note that ergotamine should not be taken concomitantly with any triptan (2).
Ergotamine has been used for the acute treatment of migraine since 1926 and has a relatively low-receptor selectivity for adrenergic serotonergic and dopamine receptors and consequently has a multitude of described adverse drug reactions (3)
- chronic ergotamine use has been associated with fibrotic processes in the retroperitoneum, pleura, pericardium and heart valves
- a review that estimated the incidence of a fibrotic side effect from methysergide, a ergotamine derivative medication, to be 1 in 5000 treated patients
The respective summary of product characteristics must be consulted before prescribing any of the durgs mentioned.
Reference:
- Drug and Therapeutics Bulletin 1998; 36(6):41-4.
- British Association of the Study of Headache (BASH) guidelines 2004.
- Tynan D, Ahmad K, Thieben M. Long-term Ergotamine Derivative Therapy for Migraine Associated with Pachymeningitis and Sixth Cranial Nerve Palsy. Neuroophthalmology. 2018 Oct 5;43(6):417-420.