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Headache Medicines, Ergot Derivative-Containing  (Systemic)

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Contents of this page:

Brand Names

Some commonly used brand names are:

In the U.S.—

  • Belcomp-PB5
  • Cafergot3
  • D.H.E. 451
  • Ergocaff-PB5
  • Ergomar2
  • Migergot3
  • Migracet-PB5
  • Wigraine3

In Canada—

  • Cafergot3
  • D.H.E.1
  • Ergodryl8
  • Gravergol7

Note:

For quick reference, the following ergot derivative-containing headache medicines are numbered to match the corresponding brand names.
This information applies to the following medicines:
1.  Dihydroergotamine (dye-hye-droe-er-GOT-a-meen)
2.  Ergotamine (er-GOT-a-meen)
3.  Ergotamine and Caffeine (er-GOT-a-meen and kaf-EEN)
4.  Ergotamine, Caffeine, and Belladonna Alkaloids (er-GOT-a-meen, kaf-EEN, and bell-a-DON-a AL-ka-loids)*
5.  Ergotamine, Caffeine, Belladonna Alkaloids, and Pentobarbital (er-GOT-a-meen, kaf-EEN, bell-a-DON-a AL-ka-loids, and pen-toe-BAR-bi-tal)
6.  Ergotamine, Caffeine, and Cyclizine (er-GOT-a-meen, kaf-EEN, and SYE-kli-zeen)*
7.  Ergotamine, Caffeine, and Dimenhydrinate (er-GOT-a-meen, kaf-EEN, and dye-men-HYE-dri-nate)*
8.  Ergotamine, Caffeine, and Diphenhydramine (er-GOT-a-meen, kaf-EEN, and dye-fen-HYE-dra-mine)*
‡  Generic name product may be available in the U.S.
§  Generic name product may be available in Canada
*  Not commercially available in the U.S.
†  Not commercially available in Canada

Category


Description

Dihydroergotamine and ergotamine belong to the group of medicines known as ergot alkaloids. They are used to treat severe, throbbing headaches, such as migraine and cluster headaches. Dihydroergotamine and ergotamine are not ordinary pain relievers. They will not relieve any kind of pain other than throbbing headaches. Because these medicines can cause serious side effects, they are usually used for patients whose headaches are not relieved by acetaminophen, aspirin, or other pain relievers.

Dihydroergotamine and ergotamine may cause blood vessels in the body to constrict (become narrower). This effect can lead to serious side effects that are caused by a decrease in the flow of blood (blood circulation) to many parts of the body.

The caffeine present in many ergotamine-containing combinations helps ergotamine work better and faster by causing more of it to be quickly absorbed into the body. The belladonna alkaloids, dimenhydrinate, and diphenhydramine in some combinations help to relieve nausea and vomiting, which often occur together with the headaches. Dimenhydrinate, diphenhydramine, and pentobarbital also help the patient relax and even sleep. This also helps relieve headaches.

Dihydroergotamine is also used for other conditions, as determined by your doctor.

These medicines are available only with your doctor's prescription, in the following dosage forms:



Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For these headache medicines, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to atropine, belladonna, pentobarbital or other barbiturates, caffeine, dimenhydrinate, diphenhydramine, or an ergot medicine. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Use of dihydroergotamine or ergotamine by pregnant women may cause serious harm, including death of the fetus and miscarriage. Therefore, these medicines should not be used during pregnancy.

Breast-feeding—

Be sure that you discuss these possible problems with your doctor before taking any of these medicines.

Children—

Older adults—

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Many medicines can add to or decrease the effects of the belladonna alkaloids, caffeine, dimenhydrinate, diphenhydramine, or pentobarbital present in some of these headache medicines. Therefore, you should tell your health care professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine. This is especially important if any medicine you take causes excitement, trouble in sleeping, dryness of the mouth, dizziness, or drowsiness.

When you are taking dihydroergotamine or ergotamine, it is especially important that your health care professional know if you are taking any of the following:

Other medical problems—The presence of other medical problems may affect the use of these headache medicines. Make sure you tell your doctor if you have any other medical problems, especially:

Also, tell your doctor if you need, or if you have recently had, an angioplasty (a procedure done to improve the flow of blood in a blocked blood vessel) or surgery on a blood vessel. The chance of serious side effects caused by dihydroergotamine or ergotamine may be increased.



Proper Use of This Medicine

Use this medicine only as directed by your doctor. Do not use more of it, and do not use it more often, than directed. If the amount you are to use does not relieve your headache, check with your doctor. Taking too much dihydroergotamine or ergotamine, or taking it too often, may cause serious effects, especially in elderly patients. Also, if a headache medicine (especially ergotamine) is used too often for migraines, it may lose its effectiveness or even cause a type of physical dependence. If this occurs, your headaches may actually get worse.

This medicine works best if you:

Your doctor may direct you to take another medicine to help prevent headaches. It is important that you follow your doctor's directions, even if your headaches continue to occur. Headache-preventing medicines may take several weeks to start working. Even after they do start working, your headaches may not go away completely. However, your headaches should occur less often, and they should be less severe and easier to relieve. This can reduce the amount of dihydroergotamine, ergotamine, or pain relievers that you need. If you do not notice any improvement after several weeks of headache-preventing treatment, check with your doctor.

For patients using dihydroergotamine:

For patients using the sublingual (under-the-tongue) tablets of ergotamine:

For patients using rectal suppository forms of a headache medicine:

Dosing—

The dose of these headache medicines will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

Storage—

To store this medicine:


Precautions While Using This Medicine

Check with your doctor:

Drinking alcoholic beverages can make headaches worse or cause new headaches to occur. People who suffer from severe headaches should probably avoid alcoholic beverages, especially during a headache.

Smoking or nicotine replacement therapy products may increase some of the harmful effects of dihydroergotamine or ergotamine. It is best to avoid smoking or the use of nicotine replacement therapy products for several hours after taking these medicines.

Dihydroergotamine and ergotamine may make you more sensitive to cold temperatures, especially if you have blood circulation problems. They tend to decrease blood flow in the skin, fingers, and toes. Dress warmly during cold weather and be careful during prolonged exposure to cold temperatures. This is especially important for older patients, who are more likely than younger adults to already have problems with their circulation.

If you have a serious infection or illness of any kind, check with your doctor before using this medicine, since you may be more sensitive to its effects.

For patients taking one of the combination medicines that contains caffeine:

Caffeine may also interfere with some other laboratory tests. Before having any other laboratory tests, tell the person in charge if you have taken a medicine that contains caffeine.

For patients taking one of the combination medicines that contains belladonna alkaloids, dimenhydrinate, diphenhydramine, or pentobarbital :


Side Effects of This Medicine

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if the following side effects occur, because they may mean that you are developing a problem with blood circulation:

Also check with your doctor immediately if any of the following side effects occur, because they may mean that you have taken an overdose of the medicine:

The following side effects may go away after a little while. Do not take any more medicine while they are present. If any of them occur together with other signs of problems with blood circulation, check with your doctor right away. Even if any of the following side effects occur without other signs of problems with blood circulation, check with your doctor if any of them continue for more than one hour:

Also, check with your doctor as soon as possible if you notice any of the following side effects:

Other side effects may occur that usually do not need medical attention. These side effects may go away after a little while. However, check with your doctor if any of the following side effects continue or are bothersome:

After you stop taking this medicine, your body may need time to adjust. The length of time this takes depends on the amount of medicine you were taking and how long you took it. During this time check with your doctor if your headaches begin again or worsen.

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.


Additional Information

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although this use is not specifically included in product labeling, dihydroergotamine is sometimes used together with another medicine (heparin) to help prevent blood clots that may occur after certain kinds of surgery. It is also used to prevent or treat low blood pressure in some patients.

For patients receiving this medicine for preventing blood clots:

For patients using this medicine to prevent or treat low blood pressure:

Other than the above information, there is no additional information relating to proper use, precautions, or side effects for these uses.

Revised: 02/20/2004

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