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PubMed1990

[Rectal resection with colo-anal anastomosis for ergotamine-induced rectal stenosis].

Anorectal ulcers due to ergotamine suppositories are extremely rare. We report the first case of rectal stenosis following regular abuse of ergotamine suppositories which required rectal resection and coloanal anastomosis, despite stopping the intoxication 1 year previously. The rectal eversion during the perineal procedure allowed a low anastomosis to be performed, on the dentate line. One year later, the functional result was considered to be good, demonstrating the place of coloanal anastomosis in benign rectal pathology.

Adult↗

PubMed1990

Mitral and aortic valve disease associated with ergotamine therapy for migraine. Report of two cases and review of literature.

Ergotamine has been associated with numerous vascular complications but only rarely with fibrosing disorders or valvular heart disease. Two patients are described in whom severe valvular dysfunction developed during ergotamine therapy for migraine headache. The surgically excised mitral and aortic valves were involved by a proliferative process that was strikingly similar to lesions described in patients with carcinoid heart disease and methysergide-associated valvular disease.

Adult↗

PubMed1986

Alpha 2-adrenergic agonist and alpha 1-adrenergic antagonist activity of ergotamine and dihydroergotamine in rats.

The effect of ergotamine and dihydroergotamine on peripheral alpha-adrenoceptors was examined in pithed rats. The pressor response to ergot alkaloids was reduced competitively by yohimbine but not by prazosin or methysergide. These results show that the vasoconstriction induced by ergot alkaloids is mediated by alpha 2-adrenoceptors. Ergot alkaloids decreased the tachycardia elicited by stimulation of the cardioaccelerator sympathetic nerves, this effect being antagonized by yohimbine. The pressor response to (-)-phenylephrine was reduced by ergot alkaloids, suggesting competitive antagonism. It is suggested that in the pithed rat both ergotamine and dihydroergotamine act at the periphery as competitive alpha 1-adrenoceptor blockers and partial alpha 2-adrenoceptor agonists.

Adrenergic alpha-Agonists↗

PubMed1979

Ergotism with therapeutic doses of ergotamine tartrate.

Two cases of acute ergotism are described in patients taking therapeutic oral doses of ergotamine tartrate and concomitant triacetyloleandomycin. Both showed satisfactory response to infusion of sodium nitroprusside with normal perfusion being obtained in the affected limbs. The treatment of ergotism with sodium nitroprusside is reviewed and the apparent interaction of ergotamine and triacetyloleandomycin is discussed.

Adult↗

PubMed1977

Analytical problems with putrefaction in a fatal case involving ergotamine and pentazocine.

A 29-year-old male drug addict was found dead at the bottom of a staircase. Analysis of the acid-hydrolized blood showed the presence of pentazocine and two characteristic compounds that contained L-phenylalanine and D-proline, linked together by peptide bounds. It was shown that the latter two components could emanate from the peptide part of ergotamine under the conditions used. It seemed likely that, at the time of analysis, pentazocine and ergotamine were present at concentrations far above therapeutic values. A third component in the blood could not be identified.

Adult↗

PubMed1981

Actions and interactions of ergotamine and dihydroergocristine in rat aortic strips.

The stimulating actions of ergotamine and serotonin were compared with that of noradrenaline on the rat isolated aorta. The results are discussed in the light of those obtained on other vascular preparations. On ergotamine or noradrenaline contracted aortic strips the antagonist activity of dihydroergocristine in comparison with that of papaverine was studied. Both agents were able to induce dose-dependent relaxations.

Animals↗

PubMed1980

Systemic availability of ergotamine tartrate in healthy subjects after single and repeated oral doses.

The studies presented indicate that ergotamine tartrate taken orally in single or repeated 2 mg doses is biologically available in most of the subjects examined. The peak plasma concentration of the drug in the ng/ml range is attained at 1-2 hours. It seems probable that there is a second rise in the plasma concentrations of the drug, possibly indicating an accumulation of ergotamine or some of its immunoreactive metabolites, and this needs further evaluation.

Administration, Oral↗

PubMed1978

[Bilateral vascular papillitis following ergotamin medication (author's transl)].

A 36-years aged woman suffering from migraine used Ergosanol special-suppositories. An edema of the retina with star figure appeared in both eyes with only a few months distance. After putting away that drug visual acuity restituted completely in spite of a partial neuritic atrophy of the optic nerve in the first suffering eye. If Ergotamin containing drugs are not used for too long time the condition usually is getting better within a few days. Thereby the diagnosis can be confirmed clinically. The same results could be expected if DHE leads to Ergotismus which is not yet confirmed. In literature central scotomas as well as annular scotomas are reported. In Ergotamin induced angioneuropathies there is a large difference in individual response. Our observation showed that drugs taken for years are no more felt as a pharmacon by a patient and therefore are not reported to the examinating physician.

Adult↗

PubMedDate not supplied

Vascular injuries in ergotamine abuse: a case report.

The case reported here concerns a 40-year-old woman who has suffered from severe migraine without aura since she was 23. The patient has been taking 1-3 suppositories of Virdex (2 mg of ergotamine tartrate, 250 mg of aminophenazone, caffeine) every day for the past three years. In addition to headache, the onset of short, sporadic cramps in the limbs together with paresthesia, hyposthenia, hypothermia and skin pallor with a slight increase in diastolic pressure, made hospital treatment necessary. Instrumental investigation through a stress test on a moving carpet, doppler, echo-doppler and digitalized angiography of the arterial vessels of the lower limbs shows the presence of bilateral impairment attributable to the chronic intake of ergotamine.

Adult↗

PubMed1993

[Ergotamine-induced rectal stenosis in a patient with long-term migraine].

A 36 year old woman was admitted to our hospital for treatment of a high-grade rectal stenosis of unknown origin. She had a history of migraine going back 10 years. On intensive questioning she admitted using up to 5 ergotamine-containing suppositories a day. On the basis of history and clinical investigations the rectal stenosis must be connected with the abuse of ergotamine-containing suppositories. This case demonstrates that patients with an unexplained rectal syndrome should be asked for analgetics-containing suppositories specifically. Only discontinuation of treatment in time can preserve the patient from development of a rectal stenosis. In case of a rectal stenosis surgical treatment can be avoided by means of endoscopic controlled dilatation.

Adult↗

PubMed1996

Clinical ergotism with lingual ischemia induced by clarithromycin-ergotamine interaction.

The macrolide class of antibiotics, including erythromycin and troleandomycin, is associated with clinically significant adverse drug interactions. This results from macrolide inhibition of cytochrome P-450 metabolism of numerous xenobiotics, resulting in elevated serum drug levels and clinical intoxication. Animal studies, however, suggest that clarithromycin, the newest approved macrolide antibiotic, has has less potential for adverse drug reactions. We describe a patient who, on her fifth day of clarithromycin therapy, developed clinical ergotism (i.e., hypertension, lingual ischemia, and peripheral cyanosis) several hours after administration of her usual 2-mg dose of ergotamine tartrate. To our knowledge, this is the first report of clinical ergotism precipitated by clarithromycin-ergotamine interaction and suggests that, like other macrolide antibiotics, ergot preparations should be avoided in patients who are taking clarithromycin.

Clarithromycin↗

PubMed1996

Aortic and mitral valve disease induced by ergotamine therapy for migraine: a case report and review of the literature.

A case of aortic and mitral valve disease associated with ergotamine abuse is reported. A 34-year-old woman presented with dyspnea after a long standing history of peripheral vascular pathology associated with ergotamine abuse. Cardiac dysfunction was rapidly progressive. At surgery, nodular thickening of both valves and fusion of the posterior leaflet of the mitral valve were seen. Microscopy revealed proliferation of myofibroblasts with little destruction of normal valvular elements. The similarity to lesions in carcinoid heart disease and in methysergide-associated valvular disease suggests direct stimulation of myofibroblast growth by serotonin agonist effect.

Adult↗

PubMedDate not supplied

[The comparison of sodium valproate and ergotamine titrate plus caffeine in the abortive treatment of migraine attacks].

The contemporary measures against migraine attacks are not fully satisfying, thus the migraine episode is still a challenge in treatment. In 1993 Hering and Steiner proposed valproic acid for the interruption of migraine attacks. The authors present the results of their own study comparing the effects of sodium valproate (SV) and ergotamine plus caffeine (Coffecorn) in this respect. 82 attacks in 20 patients were treated altogether. The effectiveness of SV was statistically not different from that of ergotamine--the drug recognized formerly as the first choice one in the abortion of migraine attacks.

Adult↗

PubMed1997

The pharmacology of ergotamine and dihydroergotamine.

The ergot alkaloids are a family of chemical entities that have many pharmacologic effects. Their diversity results from their interaction with multiple receptors, their variable receptor affinity and intrinsic activity, and their variable organ-specific receptor access. Ergotamine tartrate (ET) was one of the first ergot alkaloids to be isolated. Dihydroergotamine (DHE) is synthesized by reducing an unsaturated bond in ergotamine (E); this modification results in a changed pharmacologic profile. Dihydroergotamine exhibits greater alpha-adrenergic antagonist activity and much less potent arterial vasoconstriction and emetic potential. Both E and DHE are 5-HT1A, 5-HT1B, 5-HT1D, and 5-HT1F receptor agonists. The vasoconstrictor activities of these ergot compounds have long been believed to be the basis of their clinical effects, but recent evidence suggests that their antimigraine action may result in part from their inhibitory effects on neurogenic inflammation and neuronal transmission and not from vasoconstriction. Improvements in assay methodology have provided more accurate determination of the pharmacokinetics of E and DHE. The long duration of action appears to result from active metabolites and tight tissue binding. Intranasal (IN) administration of DHE delivers adequate plasma concentrations of the drug without the need for parenteral administration and should further expand its role in migraine pharmacotherapy.

Analgesics, Non-Narcotic↗

PubMed1997

Appropriate use of ergotamine tartrate and dihydroergotamine in the treatment of migraine: current perspectives.

Considerable uncertainty exists regarding the appropriate use and dose limitations for ergotamine tartrate (ET) and dihydroergotamine (DHE) for the treatment of migraine despite more than 50 years of clinical experience. The Quality Standards Subcommittee (QSS) of the American Academy of Neurology (AAN) appointed an advisory committee from experts in the Headache and Facial Pain Section. As their initial project, the committee elected to review the clinical literature on the appropriate use of these compounds in the treatment of migraine. Subsequently, clinical practice guidelines were formulated and recently published in Neurology. The Headache and Facial Plan Section and the QSS of the AAN were able to reach consensus on the basis of a thorough literature review and formulated practice parameters that describe and define the limits of ergot use, provide information on the oral and parenteral dosing of ET and DHE, and provide physicians with guidance to avoid ET overuse by patients. Because this project was completed prior to the availability of the intranasal (IN) formulation of DHE, intranasal DHE is not included in the practice parameter. Ergotamine tartrate and DHE were found to be safe and effective for the treatment of migraine as long as recommended dosages are not exceeded and high-risk patients such as those with uncontrolled hypertension, coronary or peripheral artery disease, thyrotoxicosis, or sepsis do not receive these compounds. In addition, the committee recommended restricting the use of ET in some instances because the overuse of ET has been associated with physical and psychological dependence resulting in predictable recurrent and/or rebound headaches, and subsequent severe withdrawal symptoms, including nausea, upon discontinuance of ET. None of these symptoms have been reported for DHE. These guidelines should help physicians provide optimal antimigraine therapy with these drugs.

Analgesics, Non-Narcotic↗

PubMed1976

[Ergotamine abuse and retroperitoneal fibrosis (author's transl)].

A case of Ergotamine abuse causing considerable fibrotic changes of the abdominal aorta and iliac vessels and of the retroperitoneal space is reported. Histological and pathogenetic aspects of the arterial changes and the retroperitoneal fibrosis are discussed. They are referred to the permanent constriction of the Vasa vasorum by Ergotamine.

Adult↗

PubMed1985

Ergotamine-induced colitis.

We report on a 45-year-old woman with ulcerative colitis of the rectum that arose after the use of up to 6 suppositories of a preparation containing ergotamine daily over a period of 6 years. On the basis of a review of the literature the clinical, endoscopic and histological features of the ergotamine-induced colitis are characterized.

Colitis, Ulcerative↗

PubMed2001

St. Anthony's fire (ergotamine induced leg ischemia)--a case report and review of the literature.

Ergotism, once an epidemic disease, is now a rare disorder. The most common manifestation is acute peripheral ischemia due to vasospasm, with an incidence of 0.001%. We report a case of a middle-age woman who presented with ergotamine-induced leg ischemia, due to chronic use of ergotamine-containing medications for migraine headaches. The diagnosis was confirmed with arteriography results, and she responded well to vasodilator therapy. The pharmacology, clinical presentation, diagnostic approach, and therapy of ergotism are reviewed.

Ergot Alkaloids↗