Home Drug Guide Ergotamine Tartrate and Caffeine

Drug Guide

Generic Name

Ergotamine Tartrate and Caffeine

Brand Names Cafergot, Migergot, Wigraine

Classification

Therapeutic: Vasoconstrictor and antimigraine agent

Pharmacological: Ergot Alkaloid and Central Nervous System stimulant

FDA Approved Indications

  • Acute treatment of migraine attacks with or without aura

Mechanism of Action

Ergotamine works by agonizing serotonin receptors (5-HT) and alpha-adrenergic receptors, leading to vasoconstriction of intracranial blood vessels. Caffeine acts as a central nervous system stimulant that enhances vasoconstriction and may improve absorption and efficacy of ergotamine.

Dosage and Administration

Adult: Typically, 1 tablet at the first sign of migraine, repeat in 30 minutes if necessary, not exceeding 6 mg in 24 hours.

Pediatric: Use is not generally recommended in children due to safety concerns.

Geriatric: Use with caution; start at lower doses and monitor closely.

Renal Impairment: Adjustments may be necessary; consult specific guidelines.

Hepatic Impairment: Use with caution; baseline liver function should be evaluated.

Pharmacokinetics

Absorption: Absorbed rapidly from gastrointestinal tract.

Distribution: Widely distributed; crosses the blood-brain barrier.

Metabolism: Metabolized primarily in the liver via oxidation.

Excretion: Excreted mainly in feces; minimal urinary excretion.

Half Life: Approximately 2 hours for ergotamine.

Contraindications

  • Known hypersensitivity to ergot alkaloids
  • Peripheral vascular disease (e.g., Raynaud's phenomenon)
  • Coronary artery disease
  • Uncontrolled hypertension
  • Pregnancy (except under specific guidance)

Precautions

  • Use with caution in hepatic or renal impairment, sepsis, or when using other vasoconstrictive drugs.

Adverse Reactions - Common

  • Nausea and vomiting (Common)
  • Vasoconstriction leading to ischemia (Uncommon)

Adverse Reactions - Serious

  • Vasospasm causing gangrene, hypersensitivity reactions, pulmonary evacuations, or seizures (Rare)

Drug-Drug Interactions

  • CYP3A4 inhibitors (e.g., macrolide antibiotics, protease inhibitors) increase risk of ergotism.
  • Triptans (serotonin receptor agonists) may increase vasospasm risk.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of vasospasm, peripheral ischemia, and gastrointestinal disturbances.

Diagnoses:

  • Risk for peripheral ischemia or gangrene
  • Ineffective tissue perfusion

Implementation: Administer as prescribed; avoid concurrent vasoconstrictive agents.

Evaluation: Assess effectiveness of migraine relief and for adverse effects.

Patient/Family Teaching

  • Instruct patient to take at the first sign of migraine.
  • Report any symptoms of coldness, numbness, or pain in fingers or toes.
  • Avoid smoking and vasoconstrictive substances.

Special Considerations

Black Box Warnings:

  • Potential for serious vasospasm with ergot derivatives, leading to ischemia in extremities and other tissues.

Genetic Factors: Genetic polymorphisms affecting CYP3A4 may alter drug metabolism.

Lab Test Interference: May interfere with laboratory assays measuring serum creatine kinase.

Overdose Management

Signs/Symptoms: Vasospasm, limb ischemia, hypertension, nausea, vomiting.

Treatment: Discontinue medication immediately; provide supportive measures, vasodilators if indicated, and monitor tissue perfusion.

Storage and Handling

Storage: Store at room temperature, away from heat and moisture.

Stability: Stable for 2-3 years when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.