Search
caffeine/ergotamine (Cafergot, Ercaf, Wigraine)
Indication: prevention or treatment of vascular headaches.
Contraindications:
1) peripheral vascular disease
2) hepatic or renal disease
3) hypertension
4) peptic ulcer disease
5) sepsis
6) avoid use during pregnancy
pregnancy-category X
safety in lactation -
Dosage:
1 mg ergotamine + 100 mg caffeine.
- 2 tabs PO at onset, then 1 every 30 min
- up to 6 tabs/24 hours
Suppositories: (2 mg ergotamine + 100 mg caffeine).
- up to 2/attack.
Pharmacokinetics:
1) absorption increases with caffeine co-administration
2) metabolized by the liver
3) metabolites eliminated in the bile
Adverse effects:
1) common (> 10%)
- localized edema
- numbness & paresthesias of fingers & toes
- drowsiness
- dizziness
- dry mouth
- diarrhea
- nausea/vomiting
2) less common (1-10%)
- angina, tachycardia, bradycardia, claudication, weakness
3) other
- arterial spasm
- vasoconstriction
- rebound headache may occur with sudden withdrawal
Drug interactions:
1) propranolol in combination may result in severe vasoconstriction
2) erythromycin & clarithromycin in combination may result in ergot toxicity
Mechanism of action:
1) direct stimulation of vascular smooth muscle to vasoconstrict peripheral & cerebral vessels
2) antagonizes serotonin activity
3) caffeine is an adjunct agent also with vasoconstrictive actions on cerebral vessels
Interactions
drug interactions
General
antimigraine combination
Database Correlations
PUBCHEM cid=125740
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
Components
caffeine (NoDoz, Vivarin)
ergotamine (Ergostat)