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Differential effects of migraine drugs on cerebral blood flow autoregulation.

The effect of the migraine drugs ergotamine and sumatriptan on the cerebral blood flow (CBF) autoregulation was studied in halothane/nitrous oxide-anesthetized normotensive Wistar Kyoto rats. Ergotamine, an ergot alkaloid affecting 5HT, norepinephrine, and dopamine receptors, was administered intravenously as a single dose of 25 microg/kg. Sumatriptan, a selective 5HT1-like receptor agonist, was administered by intravenous infusion of 300 microg/kg/h. CBF was measured with the intracarotid 133Xe-injection method. The blood pressure limits of CBF autoregulation were determined by computerized least sum of square analysis. CBF autoregulation was preserved after both ergotamine and sumatriptan. Ergotamine shifted the lower blood pressure limit of CBF autoregulation towards higher blood pressures from 60 +/- 3 mmHg to 82 +/- 4 mmHg (p<0.01), but did not significantly affect the upper blood pressure limit of CBF autoregulation. Sumatriptan had no significant effects on the blood pressure limits of CBF autoregulation.

Animals↗

[Critical ischaemia of the limbs and localized livedo in a case of ergotism].

HISTORY AND ADMISSION FINDINGS: A 57-year-old woman, a heavy smoker and migraine sufferer, was admitted with severe resting pain in the right forefoot and painful localized tendril-shaped reddening on the right thigh. She had regularly been taking 1-2 mg ergotamine tartrate, several analgesics, some containing caffeine, and selective serotonin-uptake inhibitors. Clinical examination found all limbs to be cool. On the right leg the pulse was not palpable below the inguinal line, and the reddening corresponded to localized livedo. INVESTIGATIONS: The peripheral Doppler pressure indicated critical perfusion reduction in the right leg with a tibiobrachial pressure ratio of 0.14. Colour-coded duplex sonography showed generalized vasoconstriction with filiform hourglass stenosis of the right proximal superficial femoral artery without atherosclerotic changes. The history of drug intake and the characteristic sonographic findings indicated ergotism and an arteriography was deemed unnecessary. TREATMENT AND COURSE: All ergotamine and caffeine containing drugs were discontinued and the patient urged to stop smoking. Amlidopine, 2.5 mg orally, and prostaglandin E1, 60 microgram i.v., were administered daily. The resting pain was much reduced after the first infusion and the painful livedo disappeared. The documented high-grade stenosis of the right superficial femoral artery was reduced to 25-50% by the third day of infusion. At the end of 10 daily infusions both the Doppler pressure and the duplex sonography had become normal. Pizotifen was given for the migraine and the serotonin re-uptake inhibitor sertralin was discontinued. CONCLUSION: An interaction of the serotonin re-uptake inhibitor with ergotamine was presumably responsible for the development of ergotism under >>therapeutic<< ergotamine dosage. Vasospastic stenoses and occlusions can be demonstrated by duplex sonography and may in future not require additional angiographic confirmation. Intravenous rather than intraarterial infusion of prostaglandin is to be preferred if vessels at many sites are affected. Livedo is a transitory sign of ergotism.

Arm↗

The selective closure of feline carotid arteriovenous anastomoses (AVAs) by GR43175.

The haemodynamic effects of the selective 5-HT1-like agonist GR43175 have been compared with that of ergotamine in anaesthetized cats. Both GR43175 (30-1000 micrograms/kg intravenously) and ergotamine (0.3-30 micrograms/kg intravenously) caused a dose-dependent reduction in the proportion of cardiac output passing through arteriovenous anastomoses (AVAs). However, unlike GR43175, the effect of ergotamine (30 micrograms/kg intravenously) was associated with marked increases in diastolic blood pressure and total peripheral resistance. In further studies, the effect of GR43175 on the distribution of blood flow within the carotid bed has been examined. GR43175 caused a reduction in total carotid arterial blood flow which was entirely due to a reduction in flow through carotid AVAs. These results demonstrate that GR43175, unlike ergotamine, has a highly selective vasoconstrictor action on AVAs within the cranial circulation of anaesthetized cats. Such a mechanism may be important in its antimigraine activity.

Animals↗

The impact of different antimigraine compounds on platelet and erythrocyte aggregation.

Clinical and experimental data suggest that ergotamine compounds and triptans may contribute to vascular events such as myocardial infarction and stroke. The role of blood cell aggregation in this context is, however, not clarified. We aimed to evaluate the impact of different acute antimigraine compounds on platelet and erythrocyte aggregation in a human ex vivo experimental design. In 20 healthy subjects without migraine and in 20 healthy subjects with migraine without aura, platelet and erythrocyte aggregation were measured before and after intake of placebo, acetylsalicylic acid, ergotamine tartrate, zolmitriptan and sumatriptan. Platelet aggregation was measured by the so-called platelet reactivity index. Erythrocyte aggregation was measured by photometric assessment in an aggregometer. Ergotamine tartrate induced a significant increase of platelet aggregation, whereas acetylsalicylic acid induced a significant decrease in both subject groups. After placebo, after sumatriptan and after zolmitriptan, no significant changes of platelet aggregation were noted. Erythrocyte aggregation was affected by neither compound. We can conclude that platelet aggregation, but not erythrocyte aggregation, is increased after intake of ergotamine tartrate. This may in part contribute to vascular side-effects of this compound. Acetylsalicylic acid and the triptans appeared to be safe with respect to platelet and erythrocyte aggregation.

Adult↗

Coronary side-effect potential of current and prospective antimigraine drugs.

BACKGROUND: The antimigraine drugs ergotamine and sumatriptan may cause angina-like symptoms, possibly resulting from coronary artery constriction. We compared the coronary vasoconstrictor potential of a number of current and prospective antimigraine drugs (ergotamine, dihydroergotamine, methysergide and its metabolite methylergometrine, sumatriptan, naratriptan, zolmitriptan, rizatriptan, avitriptan). METHODS AND RESULTS: Concentration-response curves to the antimigraine drugs were constructed in human isolated coronary artery segments to obtain the maximum contractile response (Emax) and the concentration eliciting 50% of Emax (EC50). The EC50 values were related to maximum plasma concentrations (Cmax) reported in patients, obtaining Cmax/EC50 ratios as an index of coronary vasoconstriction occurring in the clinical setting. Furthermore, we studied the duration of contractile responses after washout of the acutely acting antimigraine drugs to assess their disappearance from the receptor biophase. Compared with sumatriptan, all drugs were more potent (lower EC50 values) in contracting the coronary artery but had similar efficacies (Emax <25% of K+-induced contraction). The Cmax of avitriptan was 7- to 11-fold higher than its EC50 value, whereas those of the other drugs were <40% of their respective EC50 values. The contractile responses to ergotamine and dihydroergotamine persisted even after repeated washings, but those to the other drugs declined rapidly after washing. CONCLUSIONS: All current and prospective antimigraine drugs contract the human coronary artery in vitro, but in view of low efficacy, these drugs are unlikely to cause myocardial ischemia at therapeutic plasma concentrations in healthy subjects. In patients with coronary artery disease, however, these drugs must remain contraindicated. The sustained contraction by ergotamine and dihydroergotamine seems to be an important disadvantage compared with sumatriptan-like drugs.

Adolescent↗

Serotonin antagonism in isolated canine cerebral arteries.

In helically-cut strips of canine cerebral arteries, the dose-response curve of serotonin was not influenced by 10(-7) M phentolamine but was slightly moved to the right and downward at 10(-6) M. The contractile response to serotonin was unaffected by cocaine (3 X 10(-6)M), atropine (10(-6) M) and propranolol (10(-6) M). The addition of lysergic acid diethylamide (LSD), ergotamine and methysergide caused a dose-dependent contraction. Treatment with LSD (10(-9) and 10(-8) M), ergotamine (10(-10) to 10(-8) M) and methysergide (10(-8) to 10(-6) M) shifted the dose-response curve of serotonin to the right and downward in a dose-dependent manner. The inhibitory effect of methysergide was reversed by washing, while that of ergotamine was not reversed. Apparent pA2 values of LSD, ergotamine and methysergide were 9.17, 9.63 and 7.92, respectively. Contractile responses to 20 mM K+ were not significantly influenced by these blocking agents even in the highest concentrations used. It may be concluded that an alpha-adrenergic mechanism is not involved in the genesis of serotonin-induced contractions and that serotonin acts directly on serotonergic receptors in canine cerebral arteries.

Animals↗

[Progress of clinical pharmacology in essential headaches].

By testing venomotor receptors (venous-constriction test), it was possible to show a potentiation of the venous constriction effect of serotonin by methysergide and ergotamine. This 5-HT potentiation was observed only when these drugs were sampled in concentrations similar to those in therapeutic use. When ergotamine and methysergide are sampled in concentrations higher than those used in clinical practice, the expected 5-HT antagonist effect is clearly evident. We could therefore conclude that methysergide and ergotamine can be considered pro-serotonin and not anti-serotonin drugs. The pro-serotonin effect of methysergide and ergotamine might take place peripherally on vasomotor or sensitive receptors and/or at a CNS level, making up for the lack of serotonin which, according to the central theory of essential headache, provokes the painful cephalic syndrome.

5-Hydroxytryptophan↗

[Multifocal brain haemorrhage associated with migraine and medication abuse].

INTRODUCTION: Although ischemic stroke is a well known complication of migraine, cerebral hemorrhage has been uncommonly reported. CASE REPORT: We present the case of a 56-year-old woman with a long history of headache and abuse of ergotamine and antiinflamatory drugs who was admitted for generalized seizures, right hemiparesis and coma. An early brain CT scan showed multiple cortico-subcortical hemorrhages localized amongst others on right frontal, left parietal, and posterior left temporo parietal regions. In the previous two years she had increased the doses on medications containing 1 mg of ergotamine and 500 mg of dipirone consuming two to six tablets a day, and 500 to 1,500 mg of aspirin a day too. Although she exceeded the maximum ergot cumulative doses allowed of 10 mg per week, it cannot be considered a typical nor a pure manifestation of ergotism. When other possible causes of stroke were excluded, the association of migraine with the protracted vasoconstriction of ergotamine, able per se to damage the capillary endothelium, and an altered local hemostasis induced by aspirin remained as the most probable mechanism of brain bleeding. After discharge she had no motor sequelae and she could return to her usual work. A neuropsychological assessment done four months later showed subclinical cognitive deficits depending on an abnormal frontal functioning. CONCLUSION: This life-threatening and potentially disabling complication must stress to physicians about the risks of ergotamine plus aspirin abuse, drawing their efforts to prevent, to recognize and to control the propensity to self medication of some patients with daily headaches.

Anti-Inflammatory Agents, Non-Steroidal↗

Recognition and treatment of arterial insufficiency from cafergot.

Cafergot is a combination of ergotamine tartrate and caffeine and may cause symptoms of peripheral vascular insufficiency. Iatrogenic ergotism should be suspected in any patient exhibiting ischemic symptoms while receiving this medication. Progression to fulminant necrosis and gangrene can occur. Two cases are presented and the management reviewed. This effect of ergotamine tartrate and caffeine may be an idiosyncratic hypersensitivity reaction with therapeutic doses or may result from excessive medication. Iatrogenic ergotism occurs most often in women in their mid-thirties with migraine syndrome. By alpha-adrenergic agonism, as well as by possible interactions with prostaglandins, calcium, and serotonin, ergotamine causes vasoconstriction of both arteries and veins. The angiographic pattern of spasm, collateral formation, and intravascular thrombi is typical. Treatment of ergotism depends on the severity of the symptoms and the possibility of gangrene. Discontinuation of ergotamine, cigarette smoking, and caffeine may be all that is necessary in most patients. Nitroprusside is the drug of choice in the treatment of acute vascular insufficiency from ergotism, but in a less urgent situation, prazosin has also been effective. Intra-arterial balloon dilatation has also been helpful. Other forms of therapy have been supportive and the results inconsistent. Cafergot should be used with extreme caution in patients with renal or hepatic failure, peripheral vascular disease, or pregnancy. Relative contraindications include hypertension, ischemic heart disease, and Raynaud's phenomenon.

Adult↗

[Clinical experience with sumatriptan ++ in the treatment of migraine symptoms].

Although sumatriptan has proven effective in treating migraine symptoms, there have been no studies comparing this drug with non-steroid anti-inflammatory drugs (NSAIDs) and ergotamine compounds under ideal dosage and delivery conditions. Our study aimed to establish the objective and subjective effects of treatment of severe migraine attacks with subcutaneous sumatriptan in a series of patients who were resistant to or intolerant of NSAIDs or ergotamine derivatives. Twenty-three patients were treated for a total of 140 attacks of migraine (mean +/- SD = 6 +/- 4 attacks). In 26% of the patients and in 23% of the attacks the response to sumatriptan was inadequate, while the response was clearly positive in 74% of the patients and in 77% of the attacks. More than half the patients responded within the first 30 min after injection of the drug. In 52% side effects were reported, although none were severe. Side effects continued with the same intensity or decreased in 91% of the patients in the course of the study. No patient considered treatment with sumatriptan worse than treatment with ergotamines or NSAIDs, while 86% and 91% labelled sumatriptan as "better" or "much better" than NSAIDs and ergotamines, respectively. Eighteen (78%) stated that they would continue using sumatriptan for future migraine attacks. Finally, most considered price to be a factor to be taken into consideration in deciding whether to inject the drug indiscriminately.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Electrospray[+] tandem quadrupole mass spectrometry in the elucidation of ergot alkaloids chromatographed by HPLC: screening of grass or forage samples for novel toxic compounds.

Ergot alkaloids are mycotoxins generated by grass and grain pathogens such as Claviceps, for example. Ergot alkaloid-poisoning syndromes, such as tall fescue toxicosis from endophyte-infected tall fescue grass, are important veterinary problems for cattle, horses, sheep, pigs and chickens, with consequent impact on food, meat and dairy industries. Damage to livestock is of the order of a billion dollars a year in the United States alone. HPLC with UV and fluorescence detection are the predominant means of ergot alkaloid determination, with focus on quantitation of the marker compound ergovaline, although ELISA methods are undergoing investigation. These techniques are excellent for rapid detection, but of poor specificity in defining new or poorly characterized ergot alkaloids and related compounds. This paper demonstrates the facility of using electrospray(+) mass spectrometry with multiple reaction monitoring (MRM) detection during chromatographic examination of ergot alkaloid standards of lysergic acid, lysergol, ergonovine, ergovaline, ergotamine, ergocornine, ergocryptine and ergocrystine by HPLC. Ergoline-8 position epimers could be separated on the gradient HPLC system for ergocornine, ergocrystine and ergonovine and appeared as shoulders for ergotamine and ergovaline; epimers generally showed different patterns of relative intensity for specific MRM transitions. There was reasonable correspondence between retention of standards on the 2-mm ESI(+)MS phenyl-hexyl-based reverse phase column and those on the 4-mm C18-based column. Since up to 10% of clinical cases involving toxin exposure display unidentified chromatographic peaks, 11 samples of feed components associated with such cases were studied with developed MRM methods to attempt elucidation of crucial components if possible. Ergotamine appeared in all, ergovaline appeared in five and ergocornine appeared in six; ergonovine, ergocryptine, ergocrystine and lysergol also appeared in several. In addition, molecular weights of compounds newly revealed by mass spectrometry suggested ergosine, ergostine and ergoptine in four samples, for which standards were not available. Dehydrated products of ergotamine, ergocrystine and ergocornine were discovered, along with dihydrogenated ergocrystine and ergocryptine in seven of the samples, and the issue was raised as to whether dehydration was strictly an instrument-derived artifact. Finally, five of the samples, along with fescue seed standard, evidenced one or more of 14 new ergot alkaloids ranging in size from 381 to 611 molecular weight and with key mass spectral characteristics of ergot alkaloids, specifically the pair of peaks m/z 223 and 208, corresponding to the ergoline ring system and its demethylated variant, respectively. It is anticipated that findings such as these will provide impetus to future development of analytical methodology for these heretofore relatively rare ergot alkaloid species.

Animal Feed↗

A retrospective long-term analysis of the epidemiology and features of drug-induced headache.

Drug-induced headache is well known to result from the abuse of compounds taken for the treatment of primary headache. The features of drug-induced headache depend on various features including the availability of drugs, the regional health system, and psychogenic factors of the patients. We performed a retrospective study on a series of 257 consecutive German patients presenting with drug-induced headache during the period 1983-1996. Our aim study was to evaluate the demographic features, the frequency of various drugs used, in particular of ergotamine derivates, and changes in these features during the study period. The frequency of drug-induced headache among all headache patients was 8%, with a female preponderance of 81%. Drug-induced headache occurred in all age groups, predominantly in migraine patients (35%). The mean number of substances used was 2.7, mainly, acetaminophen (47.9%), ergotamine tartrate (45%), and combined analgesics (56%). We did not find a significant difference between the associations with ergotamine tartrate and dihydroergotamine, although the latter was taken less frequently. Comparing the early and late years of our study period, there were no changes in the frequency of drug-induced headache (8% versus 7%), although changes in the frequency of some drugs changed (barbiturates, ergotamine tartrate, and codeine intake decreased whereas nonsteroidal anti-inflationary drugs, combined analgesics, and sumatriptan intake increased). Our data suggest that changes in drug availability and the introduction of classification criteria and treatment recommendations did not have a major impact on the frequency of drug-induced headache.

Adult↗

[3H]8-OH-DPAT labels the 5-hydroxytryptamine uptake recognition site and the 5-HT1A binding site in the rat striatum.

The binding of [3H]8-hydroxy-2-(di-N-propylamino)-tetralin ([ 3H]8-OH-DPAT) to rat hippocampal and striatal membranes has been compared. In the hippocampus, low concentrations of [3H]8-OH-DPAT bound to a single, high affinity site which was sensitive to inhibition by spiperone, buspirone and ergotamine but not by mianserin, quipazine or (-)-propranolol. This is consistent with a selective labeling of the 5-HT1A receptor. In the striatum, [3H]8-OH-DPAT bound to two sites with high and low affinity (KD's 1.18 and 109 nM). The high affinity component was blocked by low concentrations of buspirone, spiperone and ergotamine. The low affinity component was blocked only by high concentrations of buspirone and spiperone, and was not displaced by ergotamine at concentrations up to 1 microM. The ergotamine-resistant component of striatal [3H]8-OH-DPAT binding was blocked by low concentrations of the 5-HT uptake inhibitors fluvoxamine and paroxetine, and by relatively low concentrations of 5-HT itself. Thus [3H]8-OH-DPAT labels the 5-HT transporter in the rat striatum. Unlike [3H]imipramine binding, the binding of [3H]8-OH-DPAT to the 5-HT transporter was independent of external sodium ions. It is therefore suggested that 8-OH-DPAT acts as substrate for the 5-HT transporter and labels the 5-HT recognition site of the transporter complex.

8-Hydroxy-2-(di-n-propylamino)tetralin↗

Restless legs syndrome in the older adult: diagnosis and management.

Restless legs syndrome (RLS) is common in the elderly, with an estimated prevalence of 10 to 35% in individuals over 65 years of age. RLS is characterised by paraesthesias and dysaesthesias of the legs, typically occurring in the evening. The symptoms occur at rest and result in motor restlessness; movement often temporarily relieves the symptoms. Patients with poorly controlled RLS may develop related problems including insomnia (due to sleep-onset restlessness or periodic limb movements or related sleep fragmentation) and depression. RLS can be a primary disorder that develops in the young and includes familial cases. Secondary RLS occurs in association with iron-deficiency anaemia, uraemia and polyneuropathies. Typically, RLS is misdiagnosed or undiagnosed for years. In the elderly, both primary and secondary types of the disorder are common. It is thought that RLS represents lower CNS levels of, or reduced responsiveness to, dopamine. The symptoms improve with dopaminergic therapy. Ergotamine dopamine-receptor agonists such as pergolide, and the non-ergotamine dopamine-receptor agonists pramipexole and ropinirole, are becoming more commonly used to treat RLS. The dopamine precursor levodopa, in combination with carbidopa, is another effective therapeutic agent. An advantage of levodopa is lower cost than non-ergotamine and ergotamine dopamine-receptor agonists. However, the adverse effect of symptom augmentation appears to develop more frequently with levodopa than dopamine-receptor agonists; therefore, levodopa may currently be used somewhat less often as first-line therapy. Patients with painful symptoms may respond favourably to the anticonvulsants gabapentin and carbamazepine. Opioids and hypnosedatives are helpful in selected patients; however, these agents may have troubling adverse effects in the elderly. Correction of iron deficiency improves symptoms in patients with low ferritin levels. Lifestyle modification may also be helpful. Therapy is directed at symptoms, and most symptomatic patients benefit from treatment. It is important to consider RLS in the differential diagnosis of any patient with paraesthesias of the limbs.

Aged↗

Diclofenac-potassium in migraine: a review.

UNLABELLED: The NSAID diclofenac is a potent inhibitor of prostaglandin synthesis and an established antipyretic and analgesic agent. Diclofenac-potassium was developed as an immediate-release tablet with the aim of providing rapid onset of action after oral administration. This formulation has been investigated in the acute treatment of migraine. Data from available placebo-controlled clinical trials indicate that diclofenac-potassium 50 or 100mg as an immediate-release tablet is more effective than placebo and as effective as oral sumatriptan 100mg and ergotamine plus caffeine at reducing pain intensity in patients with migraine 2 hours after initial administration. Duration of pain relief is similar for the 3 drugs but onset appears to be faster with diclofenac-potassium than with oral sumatriptan or ergotamine plus caffeine. Diclofenac-potassium appears to have favourable effects on some accompanying symptoms such as nausea and vomiting. The frequency of these symptoms was significantly lower with diclofenac-potassium than with sumatriptan in 1 study, although only a few patients had vomiting at baseline. Effects on phonophobia or photophobia did not differ between diclofenac-potassium, sumatriptan and ergotamine plus caffeine. The need for rescue medication is consistently less with diclofenac-potassium than with placebo. Data are inconsistent or scarce regarding the effects of diclofenac-potassium versus placebo on other measures such as headache recurrence and working ability. Diclofenac-potassium was generally well tolerated in clinical trials in patients with migraine. Adverse events reported most frequently (abdominal pain, tiredness and fatigue and nausea) were typically mild to moderate. CONCLUSION: Diclofenac-potassium provides rapid pain relief (within 60 to 90 minutes), is well tolerated and reduces the frequency of some of the accompanying symptoms in patients with migraine. Available trials indicate that diclofenac-potassium provides similar pain relief to sumatriptan and is at least as effective as ergotamine plus caffeine, but appears to have a greater effect on nausea and vomiting than sumatriptan and a faster onset of action than both drugs. Comparisons with other NSAIDs are lacking. Diclofenac-potassium is likely to find a role as a useful first-line option in the acute treatment of migraine.

Anti-Inflammatory Agents, Non-Steroidal↗

[Ergotism in migraine. Peripheral vascular complications in 14 patients with migraine].

The general occurrence of subclinical ergotism with reduced peripheral systolic blood pressures in patients taking ergotaminepreparations regularly for migraine and the frequent occurrence of milder symptoms indicates that severe ischaemia of the extremities is not as rare a complication as would appear from the few case reports published. The 14 cases reported here constitute the largest series published of migraine patients with acute ergotism. The patients, all women, were admitted to a vascular department over a period of 14 years. They suffered from severe ischaemia of one or more extremities after consumption of varying doses of ergotamine tartrate. Ten patients had previously exhibited symptoms of acute or chronic ergotism, but only eight were admitted with this diagnosis. Liver enzyme tests were abnormal in five out of six patients examined, while three patients had ECG signs of myocardial ischaemia, regressing during treatment. At the beginning of the period, hyperbaric oxygen at 3 ATAB was the standard treatment. Since 1980, the treatment of choice has been continous i.v. nitroglycerine infusion for 24 hours. Nine patients experienced prolonged postischaemic symptoms; one patient required a forefoot amputation and four patients had permanent ischaemic muscular damage. Increased bioavailability of ergotamine due to hepatic vasospasm is suggested as a cause of sudden reduced tolerance to ergotamine. Peripheral systolic pressures and liver function tests should be controlled in patients taking ergotamine regularly. Subclinical ergotism over a prolonged period may facilitate development of occlusive peripheral vascular disease.

Adult↗

Comparative pharmacokinetic investigations with tritium-labeled ergot alkaloids after oral and intravenous administration man.

Pharmacokinetic studies were carried out with nine tritium-labeled ergot alkaloids (dihydroergotmine, dihydroergotoxine, dihydroergostine, dihydroergocornine, dihydroergovaline, dihydroergonine, ergotamine, 1-methyl-ergotamine, and bromocriptine). Each drug was administered to 6 subjects in a randomized cross-over design as single oral and intravenous doses. Plasma levels and urinary excretion of tritium-labeled material were analyzed on a phenomenological basis by non-linear regression as a sum of exponentials. All substances showed the highest plasma concentration about 2 hours after oral administration (range 1.0-2.7 hours). The mean invasion half-life was 0.5 hours (range 0.32-1.12 hours). The mean elimination half-lives ranged from 1.4-6.2 hours for the alpha-phase and from 13 to 50 hours for the beta-phase, the longest values being observed with bromocriptine. From cumulative urinary excretion data after oral and after intravenous administration, a quotient of absorption was calculated. Values between 25 and 30% were found for most dihydrogenated drugs, namely dihydroergotamine, dihydroergotoxine, dihydroergostine, and dihydroergocornine, the only exceptions being dihydroergovaline and dihydroergonine, which were less well absorbed. Ergotamine and 1-methyl-ergotamine had an absorption quotient of about two-thirds and bromocriptine was nearly completely absorbed.

Administration, Oral↗

On the pharmacology of venous smooth muscle from dog and man.

Changes in tension of spiral strips from canine and human veins induced by various drugs are compared with results from the literature on human veins. The order of potencies of alpha-adrenoceptor stimulating amines (adrenaline greater than noradrenaline greater than dopamine greater than isoprenaline) is similar in human and canine veins. Comparison of the affinities for alpha-adrenoceptors of pharmacologic drugs (thymoxamine, indoramine, clonidine, dihydroergotamine) suggest marked differences between the alpha-adrenoceptors in veins from man and dog. Venoconstriction mediating 5-HT receptors and a very small population of beta-adrenoceptors exist in both species. Human veins are always dilated by histamine, while canine femoral veins in vitro are relaxed by lower and contracted by higher histamine concentrations. Prostaglandin F2 alpha constricts both canine femoral and human hand veins. PGA2 and PGE2 increase the tension of canine and human veins in vitro but dilate human hand veins in situ. The order of potencies of ergot alkaloids in canine femoral veins is ergotamine greater than dihydroergovaline greater than dihydroergotamine = dihydroergostine greater than methysergide, whereas in human hand veins it is ergotamine = dihydroergovaline greater than methysergide greater than dihydroergotamine greater than dihydroergostine. In dogs the venoconstrictor effect of ergotamine is mediated by at least 3 mechanisms: stimulation of [1] alpha-adrenoceptors, [2] 5-HT receptors and [3] endogenous prostaglandin synthesis. Stimulation of alpha-adrenoceptors by dihydroergotamine and of 5-HT receptors by ergotamine was confirmed on human hand veins in situ. Prejunctional receptors at sympathetic nerve terminals are involved in the regulation of venous tone. Inhibitory alpha-adrenoceptors, dopamine and PGE2 receptors as well as facilitating beta-adrenoceptor existing at human vasoconstrictor nerves may be stimulated or blocked by pharmacologic drugs thereby modifying venous tone.

Adrenergic alpha-Antagonists↗