Ergotamine Tartrate

A to Z Drug Facts

Ergotamine Tartrate

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

ehr-GOT-ah-meen TAR-trate

Ergomar

Class: Ergotamine derivatives

Action Reduces extracranial blood flow, causes decline in amplitude of pulsation in the cranial arteries and decreases hyperperfusion of the territory of the basilar artery; produces constriction of both arteries and veins.

Absorption: Poorly absorbed following GI and SL administration.

Metabolism: Metabolized by the liver.

Elimination: T_1/2 is approximately 2 hr; 90% of metabolites are excreted in the bile. Unmetabolized ergotamine is erratically excreted in the saliva and trace amounts are excreted in the feces and urine.

Indications Abort or prevent vascular headache (eg, migraine).

Contraindications Peripheral vascular disease; coronary heart disease; hypertension; impaired hepatic or renal function; severe pruritus; sepsis; hypersensitivity to any component of the product; pregnancy.

Route/Dosage

SL 2 mg under tongue at first sign of attack or to relieve symptoms after onset of an attack; another tablet should be taken at 30 min intervals thereafter, if necessary (max, 6 mg/24 hr and 10 mg in any 1 wk).

Interactions

Troleandomycin May elevate ergotamine plasma levels, increasing the pharmacologic and adverse effects.

Lab Test Interferences None well documented.

Adverse Reactions

CARDIOVASCULAR: Transient changes in heart rate. GI: Nausea; vomiting. OTHER: Weakness of legs, limb muscle pain; numbness and tingling of the fingers and toes; precordial pain; localized edema; itching.

Precautions

Pregnancy: Category X. Lactation: Excreted in breast milk. Ergotism: Signs and symptoms are rare; however, remain within limits of recommended dosage. Dependency: Prolonged use may result in dependency and increase the dose requirement for relief of vascular headaches and to prevent dysphoria following withdrawal of the drug.

PATIENT CARE CONSIDERATIONS

Administration/Storage

For sublingual administration only. Do not crush, chew, or swallow tablet.
Place 1 tablet under the tongue at the first sign of migraine attack or to relieve symptoms after onset of attack.
May repeat dose at 30-min intervals if necessary, but total dose should not exceed 3 tablets in any 24-hr period or 5 tablets in any 1 wk.
Administer without regard to meals.
Do not administer within 24 hr of treatment with another 5-HT₁ agonist or other ergot- containing or ergot-type drug (eg, methysergide).
Store at controlled room temperature (59° to 86°F). Protect from light and heat.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies. Note history of peripheral vascular disease, ischemic or vasospastic coronary artery disease, hypertension, hepatic or renal impairment, childbearing potential, hemiplegic or basilar migraine.
Note recent (within 24 hr) use of 5-HT₁ agonists or other ergotamine-containing or ergot-type drugs (eg, methysergide).
Ensure that women of childbearing potential are not pregnant before administering medication.
Assess pain location, intensity, duration, and associated symptoms of migraine attack.
Obtain baseline vital signs, with special attention to pulse and BP.
Provide quiet, calm environment. Decrease stimuli, noise, and light.
Monitor patient for effectiveness of headache relief and minimal effective dose.
Monitor patient for CNS, CV, GI, musculoskeletal, and general body side effects. Report to health care provider if noted and significant.
Discontinue therapy and notify health care provider immediately if any of the following occur: numbness, tingling, coldness, or paleness in the fingers or toes; muscle pain in arms or legs; weakness in the legs; chest pain, tightness or pressure; changes in heart rate; sudden worsening of headache; swelling; itching.

OVERDOSAGE: SIGNS & SYMPTOMS

Nausea, vomiting, weakness of the legs, pain in limb muscles, numbness, itching of fingers and toes, precordial pain, tachycardia, bradycardia, hypertension, hypotension, localized edema, itching together with signs and symptoms of ischemia caused by vasoconstriction of peripheral arteries and arterioles, cold, pale and numb feet and hands, muscle pain while walking and later at rest, gangrene, confusion, depression, drowsiness, convulsions

Patient/Family Education

Explain name, dose, action, and potential side effects of drug.
Explain that drug is to be used only during migraine and does not prevent or reduce the number of attacks. Emphasize that drug is used only to treat actual migraine attack.
Instruct patient in proper use of sublingual tablet. Caution patient not to chew, crush, or swallow tablet.
Advise patient that drug is to be taken as soon as symptoms of migraine appear, and that the dose may be repeated q 30 min if needed but that no more than 3 tablets should be used in any 24-hr period or 5 tablets used in any 1-wk period.
Caution patient not to exceed the dosing guidelines because of the risk of toxic effects developing.
Advise patient to stop taking the drug and notify their health care provider if any of the following occur: numbness, tingling, coldness, or paleness in the fingers or toes; muscle pain in arms or legs; weakness in the legs; chest pain, tightness or pressure; changes in heart rate; sudden worsening of headache; swelling; itching.
Instruct patient that if they have migraine prophylactic medications prescribed to take daily as directed.
Advise patient that if not currently taking a migraine prophylactic drug to discuss the use of such drugs with health care provider.
Advise women to inform health care provider if pregnant, planning to become pregnant, or breastfeeding.
Warn patient not to take any prescription or OTC drugs or dietary supplements without consulting health care provider.
Advise patient that follow-up visits may be necessary to monitor therapy and to keep appointments.