Caffeine + Ergotamine Tartrate

Indications

Caffeine + Ergotamine Tartrate is used for: Acute Migraine

Adult Dose

Adult: PO: Each tablet contains ergotamine tartrate 2 mg and caffeine hydrate 100 mg. Initially, 1 tablet, additional doses of ½-1 tablet may be taken at half-hrly intervals, if needed. To be taken as soon as possible at the 1st warning of a migraine attack. Max: 3 tablets in 24 hr, 4 tablets per attack, 6 tablets per wk and 2 courses of treatment per mth. Ensure an interval of at least 4 days between successive treatment courses. Suppository: 1 suppository should be taken at the first sign of a migraine attack. If not relief from the first dose, a 2nd dose may be taken no sooner than 1 hour after the first dose. The use of this suppository should not be used on a daily basis. Maximum 2 suppositories for any single migraine attack and maximum 5 suppositories during any 7-day period.

Child Dose

Renal Dose

Administration

Contra Indications

Not to be used with potent inhibitors of CYP3A4 and protease inhibitors. Hyperthyroidism, renal or hepatic impairment. Pre-existing vascular disease including coronary disease, obliterative vascular disease, angina, claudication, peripheral ischaemia, Raynaud's syndrome and hypertension. Not to be used when there is sepsis. Pregnancy and lactation.

Precautions

Not to be taken regularly or used for migraine prophylaxis. Increased risk of arterial constriction and other symptoms of ergotism. Discontinue treatment when symptoms of arterial occlusion occur e.g. numbness and tingling of the extremities. Caution when used in patients with infective hepatitis, cardiac disease or anaemia. GI tract obstructive disease, glaucoma, prostatic hypertrophy or urinary retention may be worsened by cyclizine. May increase risk of retroperitoneal and/or pleuropulmonary fibrosis. Not recommended for use with other vasoconstrictors. Elderly.

Pregnancy-Lactation

Interactions

Increased sedative effect when used with alcohol. Caffeine may increase clearance of lithium. Clearance of caffeine may be reduced when used with oestrogens, progesterones, mexiletine, fluvoxamine, disulfiram or quinoline antibacterials. Serum levels of ergotamine-containing drugs may be increased when used with macrolide antibacterials. Concurrent use with MAOIs or TCAs may increase the sedative and antimuscarinic effects of cyclizine. Increased clearance of caffeine by phenytoin. Increased risk of arterial occlusion with methysergide and vasospasm with 5-HT1 agonists. Avoid ergotamine for 6 hr after almotriptan, sumatriptan, rizatriptan and zolmitriptan, and for 24 hr after eletriptan. Avoid almotriptan, eletriptan, sumatriptan and rizatriptan for 24 hr, and zolmitriptan for 6 hr, after ergotamine. Increased sedative effects when used with anxiolytics and hypnotics. Increased risk of vasoconstriction when used with β-blockers or nicotine. May reduce anti-anginal effects of glyceryl trinitrate. May increase plasma levels of theophylline. Potentially Fatal: Concurrent use with HIV-proteases which are potent CYP3A4 inhibitors (e.g. amprenavir, indinavir, nelfinavir, ritonavir) is not recommended due to increased risk of ergotism.

Adverse Effects

Side effects of Caffeine + Ergotamine Tartrate : Increased BP, hypotension, rapid and weak pulse, palpitations, arrhythmias, precordial pain, coronary infarction, fibrotic thickening of the heart valves. Cerebral ischaemia and thrombosis, blurred vision, sleep disturbances, urinary retention, muscle cramps and joint pains. GI symptoms such as nausea, vomiting, constipation, abdominal pain. Dysaesthesia, paraesthesia, formication, tremor, convulsions, headache, extrapyramidal effects. Anxiety, depression, confusion, hallucinations, psychomotor impairment.

Mechanism of Action

Ergotamine is an alpha-adrenergic blocker with a direct stimulating effect on the smooth muscle of peripheral and cranial blood vessels, it also depresses central vasomotor centers. Caffeine is also a cranial vasoconstrictor.