Ergotamine
Ergotamine, sold under the brand name Ergomar among others, is an ergopeptine and part of the ergot family of alkaloids; it is structurally and biochemically closely related to ergoline. It is structurally similar to several neurotransmitters, and it acts as a vasoconstrictor. It is used for acute migraines, sometimes with caffeine as the combination ergotamine/caffeine.
The drug is a non-selective modulator or agonist of serotonin receptors and other receptors. It is peripherally selective and crosses into the brain in minimal amounts.
Medicinal use of ergot fungus began in the 16th century, for the induction of childbirth; but dosage uncertainty discouraged its use. It has been used to prevent post-partum hemorrhage. It was first isolated from the ergot fungus by Arthur Stoll, at Sandoz in 1918, and was marketed as Gynergen in 1921.
Medical uses
Ergotamine is indicated as therapy to abort or prevent vascular headache.Available forms
Ergotamine is available as a suppository and as a tablet, sometimes in combination with caffeine.Contraindications
Contraindications include: atherosclerosis, Buerger's syndrome, coronary artery disease, hepatic disease, pregnancy, pruritus, Raynaud's syndrome, and renal disease.It's also contraindicated if patient is taking macrolide antibiotics, certain HIV protease inhibitors, certain azole antifungals delavirdine, efavirenz, or a 5-HT1 receptor agonist.
Side effects
Side effects of ergotamine include nausea and vomiting. At higher doses, it can cause raised arterial blood pressure, vasoconstriction and bradycardia or tachycardia. Severe vasoconstriction may cause symptoms of intermittent claudication.Pharmacology
Pharmacodynamics
Ergotamine interacts with serotonin, adrenergic, and dopamine receptors. It is an agonist of serotonin receptors including the serotonin 5-HT1 and 5-HT2 subtypes. Ergotamine is an agonist of the serotonin 5-HT2B receptor and has been associated with cardiac valvulopathy. Despite acting as a potent serotonin 5-HT2A receptor agonist, ergotamine is said to be non-hallucinogenic similarly to lisuride. This has been posited to be due to functional selectivity at the serotonin 5-HT2A receptor. However, ergotamine is also peripherally selective, which may instead account for its lack of psychedelic effects.Pharmacokinetics
The bioavailability of ergotamine is around 2% orally, 6% rectally, and 100% by intramuscular or intravenous injection. The low oral and rectal bioavailability is due to low gastrointestinal absorption and high first-pass metabolism.However, ergotamine does not readily cross the blood–brain barrier and hence is peripherally selective. This is due to it being an avid substrate for P-glycoprotein and breast cancer resistance protein. Only minimal amounts of the drug cross into the brain.