$Unique_ID{BRK03146} $Pretitle{} $Title{ergotamine and caffeine combination} $Subject{Cafergot Sandoz Cafetrate Schein Wigraine Organon Antimigraine vasoconstrictor ergotamine caffeine migraine cluster headaches blood vessels flow pressure pain constricting narrowing gastrointestinal tract} $Volume{} $Log{} Copyright (C) 1993 Publications International, Ltd. ergotamine and caffeine combination ------------------------------------------------------------------------------ BRAND NAMES (Manufacturers) Cafergot (Sandoz) Cafetrate (Schein) Wigraine (Organon) TYPE OF DRUG Antimigraine (vasoconstrictor) INGREDIENTS ergotamine and caffeine DOSAGE FORMS Tablets (1 mg ergotamine, 100 mg caffeine) Suppositories (2 mg ergotamine, 100 mg caffeine) STORAGE Ergotamine and caffeine combination tablets should be stored at room temperature in tightly closed, light-resistant containers. They should also be stored away from heat and direct sunlight. The suppository form of this drug should be kept in the refrigerator (never frozen) in a closed container. USES This medication is used to treat migraine and cluster headaches. These headaches are thought to be caused by an increase in the diameter of the blood vessels in the head, which results in increased blood flow, increased pressure, and pain. Ergotamine is a vasoconstrictor: it acts by constricting (narrowing) the blood vessels. Caffeine helps in both the absorption of the drug from the gastrointestinal tract and in constricting blood vessels. TREATMENT It is best to take this medication as soon as you notice your migraine headache symptoms. If you wait until the headache becomes severe, the drug takes longer to work and may not be as effective. After you take either of these forms of ergotamine and caffeine combination, you should try to lie down in a quiet, dark room for at least two hours (in order to help the medication work). The drug usually takes effect within 30 to 60 minutes. It is very important that you understand how often you can repeat a dose of this medication during an attack (usually every 30 to 60 minutes) and the maximum number of tablets you can take per day (usually six tablets). Ten is generally the maximum number of tablets that can be taken in any one-week period. CHECK WITH YOUR DOCTOR if you have any questions. The tablets should be swallowed with liquid. Take one tablet when you first notice your migraine headache symptoms. If necessary, take a second dose 30 to 60 minutes later to relieve your headache. To use the suppository form of this medication, first unwrap it and moisten it slightly with water (if the suppository is too soft to insert, run cold water over it or refrigerate it for 30 minutes before you unwrap it). Lie down on your left side, with your right knee bent. Push the suppository well into the rectum with your finger. Try to avoid having a bowel movement for at least an hour to give the medication time to be absorbed. Insert one suppository when you first notice your migraine symptoms. If necessary, insert a second suppository one hour later for full relief of your migraine headache. Five is generally the maximum number of suppositories that can be taken in a one-week period. If you are on prolonged treatment with this drug and you miss a dose, take it as soon as you remember. Wait four hours to take the next dose. It is very important that you consult your doctor before you discontinue using ergotamine and caffeine combination. Your doctor may want to reduce your dosage gradually. SIDE EFFECTS Minor. Diarrhea, dizziness, headache, nausea, nervousness or jitters, vomiting, or sensation of cold hands and feet with MILD numbness or tingling. These side effects should disappear as your body adjusts to the medication. Major. Tell your doctor about any side effects that are persistent or particularly bothersome. IT IS ESPECIALLY IMPORTANT TO TELL YOUR DOCTOR about chest pain; coldness, numbness, pain, tingling, or dark discoloration of the fingers or toes; confusion; fluid retention; itching; localized swelling; muscle pain; severe abdominal pain and swelling; severe nausea or vomiting; or unusual weakness. INTERACTIONS Ergotamine and caffeine combination interacts with several other types of medications: 1. Ergotamine interacts with amphetamines, ephedrine, epinephrine (adrenaline), pseudoephedrine, erythromycin, and troleandomycin. Such combinations can lead to increases in blood pressure or increased risk of adverse reaction to ergotamine. 2. Do not drink alcoholic beverages while you are taking this medication. Since alcohol dilates (widens) the blood vessels, drinking will only make your headache worse. 3. Tobacco and cocaine decrease the effectiveness of ergotamine and can make the headache worse. 4. The caffeine in tea, coffee, and cola drinks also interacts with this medication. BE SURE TO TELL YOUR DOCTOR about any medications or substances you are currently taking or using, especially any of those listed above. WARNINGS * Tell your doctor about unusual or allergic reactions you have had to medications, especially to ergotamine, caffeine, or any ergot alkaloid (ergonovine, ergoloid mesylates, and bromocriptine). * Before starting to take ergotamine and caffeine combination, be sure to tell your doctor if you now have or if you have ever had heart or blood vessel disease, high blood pressure, infections, kidney disease, liver disease, or thyroid disease. * Avoid any foods to which you are allergic--they may make your headache worse. * If this drug makes you dizzy or drowsy, do not take part in any activity that requires alertness, such as driving a car or operating potentially dangerous equipment. * Since this drug acts by constricting blood vessels throughout the body (not just in the head), your fingers and toes may become especially sensitive to the cold. * Elderly patients are more sensitive to the effects of ergotamine. * This medication should not be taken for longer periods or in higher doses than recommended by your doctor. Extended use of this drug can lead to serious side effects. In addition, your body can develop a tolerance to this medication--higher doses would be required to obtain the same beneficial effects and, at the same time, the risk of side effects would be increased. * Be sure to tell your doctor if you are pregnant. This medication can cause contractions of the uterus, which can harm the developing fetus. This drug should not be used during pregnancy. Also, tell your doctor if you are breast-feeding an infant. Ergotamine and caffeine combination passes into breast milk and may cause vomiting, diarrhea, irritability, or convulsions in the nursing infant. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.