Nurses Compass
Drug Guide
Ergotamine Tartrate and Caffeine
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/ADrug-Herb Interactions
N/ANursing 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.