HA- Ergots DI Flashcards
Ergots used in migraine treatment
Ergotamine, dihydroergotamine
Ergots MoA
Activation of 5-HT10 and 5-HT18 receptors on intracranial blood vessels → vasoconstriction and/or activation of 5-HT10 receptors on sensory nerve endings of the trigeminal system → inhibition of proinflammatory neuropeptide release
Ergotamine indication
ACUTE treatment of moderate-severe migraine
Ergotamine side effects
N/V, ECG changes, HTN, ischemia, vasospasm, numbness, paresthesia, gangrene
Ergotamine is not recommended in what patients?
Older adults
What happens if you D/C ergotamine
May result in withdrawal symptoms like rebound HA
Ergotamine and grapefruit juice
Increased ergotamine levels, may worsen N/V
When should you consider ergotamine?
It’s not your first-line option, but consider in patients with migraines that last more than 2 days or have frequent occurrence
Dihydroergotamine indications
Depends on the formulation:
Injection: acute treatment of cluster HA
Injection and nasal spray: acute treatment of migraine HA with or without aura
Dihydroergotamine montioring
CAD risk factors, CV evaluation –> administer the first dose in an adequately equipped facility and obtain ECG after first dose in patients with CAD risk factors
ADEs of ergots
Cardiac valvular fibrosis, ergotism, serotonin syndrome
BBW for ergots
CI’ed with potent 3A4 inhibitors (protease inhibitors, macrolide ABX, azalea antifungals)
Ergot CIs
Pregnancy and breastfeeding
Peripheral vascular disease, CAD< hepaticc or renal impairment, uncontrolled HTN, sepsis
Don’t use ergots within 24 hours of what?
Triptans, other serotonin agonists, ergot-containing or ergot-like agents
Ergot monitoring
renal and liver function, CV status
