caffeine/ergotamine (Cafergot, Ercaf, Wigraine)
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Indications
prevention or treatment of vascular headaches
Contraindications
- peripheral vascular disease
- hepatic or renal disease
- hypertension
- peptic ulcer disease
- sepsis
- avoid use during pregnancy
Dosage
1 mg ergotamine + 100 mg caffeine.
- 2 tabs PO at onset, then 1 every 30 min
- up to 6 tabs/24 hours
Suppositories: (2 mg ergotamine + 100 mg caffeine).
- up to 2/attack.
Pharmacokinetics
- absorption increases with caffeine co-administration
- metabolized by the liver
- metabolites eliminated in the bile
Adverse effects
- common (> 10%)
- localized edema
- numbness & paresthesias of fingers & toes
- drowsiness
- dizziness
- dry mouth
- diarrhea
- nausea/vomiting
- less common (1-10%)
- other
- arterial spasm
- vasoconstriction
- rebound headache may occur with sudden withdrawal
Drug interactions
- propranolol in combination may result in severe vasoconstriction
- erythromycin & clarithromycin in combination may result in ergot toxicity
- drug interaction(s) of MAO inhibitor with caffeine
- drug interaction(s) of methotrexate with caffeine
Mechanism of action
- direct stimulation of vascular smooth muscle to vasoconstrict peripheral & cerebral vessels
- antagonizes serotonin activity
- caffeine is an adjunct agent also with vasoconstrictive actions on cerebral vessels
More general terms
Components
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998