Cafergot

(Caffeine/ Ergotamine Tartrate)

The mechanism of action of Cafergot in relieving migraine is not completely understood. Ergotamine works by acting on serotonin receptors (including 5-HT1 and 5-HT2), adrenergic receptors, and dopamine receptors, which can affect blood vessels and pain pathways involved in migraine. Caffeine is included to help increase the absorption of ergotamine and may improve migraine relief.

Follow all directions given to you by your doctor and read all documents provided, including the full Prescribing Information, FDA-Approved Product Labeling, Instructions for Use, and Medication Guide before using Cafergot. However, the following is a synopsis of the general guidelines for the use of Cafergot:

Cafergot is taken by mouth as tablets for acute migraine attacks in adults.

It is not intended for daily, long-term, or preventive use.

It should not be used for cluster headache or certain rare migraine types such as basilar-type or hemiplegic migraine.

If symptoms do not improve or worsen, contact your healthcare provider.

Some mild or common side effects of Cafergot seen in clinical trials as compared to placebo include:

Nausea.

Vomiting.

Some individuals may experience serious side effects while using Cafergot. These side effects may require immediate medical attention. If you experience any of the following, contact your healthcare provider or seek emergency medical help:

Chest pain or tightness, increased heart rate (possible heart-related effects).

Signs of ergotism: severe muscle pain, numbness, or coldness in the hands or feet (possible reduced blood flow).

Fibrosis: shortness of breath, cough, lower back pain, or difficulty passing urine.

Severe allergic reaction symptoms, such as swelling or trouble breathing.

These are not all of the possible side effects of ergotamine. You should always seek medical advice from your healthcare provider for any questions or concerns about your medical condition or treatment. Read all patient information, medication guides, or drug information sheets that come with this medication. You can also report adverse effects to the Food and Drug Administration at www.fda.gov/medwatch or 1-800-FDA-1088.

Before starting Cafergot, it is crucial to discuss any existing health conditions with your healthcare provider. You should be sure that your healthcare provider is aware of all your medical conditions, including:

Any heart disease, previous stroke, or circulation problems.

High blood pressure, especially if severe or uncontrolled.

Liver disease or kidney disease.

Pregnancy or breastfeeding plans.

Heart disease, history of stroke or "mini-stroke" (transient ischemic attack), or peripheral vascular disease.

Severe or uncontrolled hypertension.

Sporadic hemiplegic, familial hemiplegic, basilar-type, ophthalmoplegic migraine, and headache attributed to arteritis.

Severe liver or severe renal impairment.

Pregnancy.

Breastfeeding.

Hypersensitivity to ergot alkaloids, caffeine, or other ingredients.

Use within 24 hours of triptans (5HT1 receptor agonists) or other ergot-containing drugs due to additive blood vessel spasm.

Use within 72 hours of certain potent CYP3A4 inhibitors, due to the risk of life-threatening ergot toxicity (ergotism).

Cafergot is used for acute migraine attacks, and its effects occur as the medication is absorbed. Peak ergotamine levels occur about 1 to 2 hours after oral dosing.

When Cafergot is taken with other prescription drugs, over-the-counter medications, vitamins, and supplements, it may change how they work or increase the frequency or severity of side effects. Make sure that you tell your healthcare professional about anything that you are taking to avoid any negative drug interactions, including:

Macrolide antibiotics such as troleandomycin, clarithromycin, and erythromycin may increase ergotamine blood levels by inhibiting CYP3A4 metabolism.

Protease inhibitors such as ritonavir, indinavir, or nelfinavir may increase ergotamine blood levels by inhibiting CYP3A4 metabolism.

Azole antifungals such as ketoconazole, itraconazole, and voriconazole may increase ergotamine blood levels by inhibiting CYP3A4 metabolism.

Other less potent CYP3A4 inhibitors, such as saquinavir, fluconazole, nefazodone, fluoxetine, grapefruit juice, fluvoxamine, zileuton, metronidazole, and clotrimazole, may increase the risk of serious toxicity due to higher ergotamine exposure.

Beta-blockers such as propranolol may lead to vasospastic reactions.

Triptans (5HT1 receptor agonists) such as rizatriptan, eletriptan, or sumatriptan, or other ergotamine-containing drugs (including dihydroergotamine and methysergide), because effects on blood vessel narrowing may be additive and dangerous.

It is available in tablets containing 1mg of ergotamine tartrate and 100mg caffeine.

It should be stored at room temperature, away from the reach of children or pets.

Cafergot is manufactured by Novartis Pharmaceuticals Canada Inc.

No, there is currently no generic version available.

Do not take Cafergot daily or long-term. If you find you need it frequently, or your migraines worsen, speak to your healthcare provider so your treatment plan can be reassessed.

No. Cafergot must not be used during pregnancy because ergotamine can affect blood flow to the placenta and may cause fetal harm or miscarriage.

No. Ergotamine is excreted into breast milk and may cause serious side effects in infants.