Dosing & Uses
Dosage Forms & Strengths
tablet, SL
- 2 mg
Migraine
2 mg SL followed by 1-2 mg q30min until attack abated; not to exceed 6 mg/day and no more than 10 mg/week OR
Menopausal Hot Flashes
0.6 mg PO q12hr (as fixed combo with belladonna and phenobarbital)
Not to exceed 10 mg/week
Commercial oral tablets discontinued in USA; may be compounded
Dosage Forms & Strengths
tablet, SL
- 2 mg
Migraine (Off-label)
1 mg SL, THEN 1 mg q30min PRN, not to exceed 3 mg/episode
Not for very young children
Use not recommended
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Adverse Effects
Frequency Not Defined
Abnormal heart valve findings (chronic use)
Angina
Arrhythmia
Vascular spasm
Vasoconstriction
Tachycardia
Fatigue
Numbness of extremities
Rebound headache
Abdominal pain
Ergotism
Possible gangrene
Paresthesia
Pruritis
Nausea
Vomiting
Muscle weakness
Visual disturbances
Warnings
Black Box Warnings
Serious and/or life threatening peripheral ischemia has been reported with coadministration of this drug with potent CYP 3A4 inhibitors (including protease inhibitors and macrolide antibiotics). Because CYP3A4 inhibition elevates the serum levels of ergotamine, the risk of vasospasm leading to cerebral ischemia and/or ischemia of the extremities is increased. Concurrent use of these drugs is contraindicated.
Contraindications
Hypersensitivity, PVD, CAD, Raynaud's phenomenon, pregnancy/lactation, sepsis, impaired renal or hepatic function, malnutrition, severe HTN
Concomitant strong CYP3A4 inhibitors
Cautions
Should be initiated at first sign of vascular headache
Ineffective for muscle contraction headache
Discontinue if S/S of impaired circulation
Possibility of retroperitoneal and pleuropulmonary fibrosis; paresthesia; GI disturbance; chest pain
May exacerbate heart failure
Safety/efficacy not established for peds
Many brands discontinued
Pregnancy & Lactation
Pregnancy Category: X
Lactation: enters breast milk, do not nurse
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Stimulates alpha receptors to vasoconstrict vessels with low vascular tone; vasodilates hypertonic vessels; at higher doses competes for alpha receptor to block it
Pharmacokinetics
Half-Life, elimination: 21 hr
Onset: Caffeine may enhance
Peak Plasma Time: 0.5-3 hr
Metabolism: Liver CYP3A4
Excretion: 90% bile
Dialyzable: Yes
Images
Patient Handout
Formulary
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