What is Migergot, and how does it work?
Migergot (ergotamine tartrate and caffeine suppositories) is a combination of an alpha-blocker and a stimulant and vasoconstrictor indicated as therapy to abort or prevent vascular headache, e.g., migraine, migraine variants or so-called
“histaminic cephalalgia.”
What are the side effects of Migergot?
WARNING
Serious and/or life-threatening peripheral ischemia has been associated with the coadministration of ergotamine tartrate and caffeine with potent CYP 3A4 inhibitors including protease inhibitors and macrolide antibiotics.
Because CYP 3A4 inhibition elevates the serum levels of ergotamine tartrate and caffeine, the risk for vasospasm leading to cerebral ischemia and/or ischemia of the extremities is increased. Hence, concomitant use of these medications is contraindicated.
Common side effects of Migergot include:
- low blood supply and oxygen (ischemia),
- bluish skin color,
- cold extremities,
- chest pain,
- EKG changes, muscle pains,
- temporary fast or slow heart rate,
- high blood pressure (hypertension),
- nausea,
- vomiting,
- rectal or anal ulcer (from overuse of suppositories),
- numbness and tingling,
- weakness,
- spinning sensation (vertigo), and
- localized swelling and
- itching
Does Migergot cause addiction or withdrawal symptoms?
Drug Abuse And Dependence
There have been reports of drug abuse and psychological dependence in patients on ergotamine tartrate and caffeine therapy. Due to the chronicity of vascular headaches, it is imperative that patients be advised not to exceed recommended dosages with long-term use to avoid ergotism.
What is the dosage for Migergot?
Ergotamine Tartrate And Caffeine
Indicated as therapy to abort or prevent vascular headache, e.g., migraine, migraine variants or so-called
histaminic cephalalgia.
Procedure
- For best results, dosage should start at the first sign of an attack.
Rectally
- Two suppositories is the maximum dose for an individual attack.
Total weekly dosage should not exceed 5 suppositories. Ergotamine Tartrate and Caffeine Suppositories should not be used for chronic daily administration.
In carefully selected patients, with due consideration of maximum dosage recommendations, administration of the drug at bedtime may be an appropriate short-term preventive measure.
What drugs interact with Migergot?
CYP 3A4 Inhibitors (e.g. Macrolide Antibiotics And Protease Inhibitors)
- Ergotamine tartrate and caffeine should not be administered with other vasoconstrictors.
- Use with sympathomimetics (pressor agents) may cause extreme elevation of blood pressure.
- The beta-blocker Inderal (propranolol) has been reported to potentiate the vasoconstrictive action of ergotamine tartrate and caffeine by blocking the vasodilating property of epinephrine.
- Nicotine may provoke vasoconstriction in some patients, predisposing to a greater ischemic response to ergot therapy.
- The blood levels of ergotamine-containing drugs are reported to be elevated by the concomitant administration of macrolide antibiotics and vasospastic reactions have been reported with therapeutic doses of the ergotamine-containing drugs when coadministered with these antibiotics.
Is Migergot safe to use while pregnant or breastfeeding?
- There are no studies on the placental transfer or teratogenicity of the combined products of ergotamine tartrate and caffeine. Caffeine is known to cross the placenta and has been shown to be teratogenic in animals.
- Ergotamine crosses the placenta in small amounts, although it does not appear to be embryotoxic in this quantity. However, prolonged vasoconstriction of the uterine vessels and/or increased myometrial tone leading to reduced myometrial and placental blood flow may have contributed to fetal growth retardation observed in animals.
- Ergotamine tartrate and caffeine is contraindicated in labor and delivery due to its oxytocic effect which is maximal in the third trimester.
- Ergot drugs are known to inhibit prolactin but there are no reports of decreased lactation with ergotamine tartrate and caffeine.
- Ergotamine is excreted in breast milk and may cause symptoms of vomiting, diarrhea, weak pulse and unstable blood pressure in nursing infants.
- Because of the potential for serious adverse reactions in nursing infants from ergotamine tartrate and caffeine, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.