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SummaryAdverse reactions to ergotamine were noted in 16 out of 41 studies in which therapeutic doses of the drug were given to normal, healthy volunteers. In 17 of the studies 0 25 mg ergotamine was given by injection, 6 i.v. and 11 i.m., in 20 studies 2 mg ergotamine was given by mouth, and 4 subjects received 2 mg ergotamine by suppository. Plasma and urinary ergotamine was measured by radio-immunoassay. Adverse reactions were significantly more frequent in subjects in whom plasma ergotamine exceeded 1-8 ng/ml.Pharmacokinetic data derived from the study are presented and their relevance to the therapeutic use of ergotamine are discussed. IntroductionAlthough ergotamine tartrate has been used in the treatment of migraine headache for more than 50 years (Dalessio, 1972) little is known about its rate of absorption, distribution, metabolism and excretion in man or about the relationship between plasma concentrations and toxic effects. Some information has come from recent pharmacokinetic studies using tritiated ergotamine (Aellig and Nuesch, 1977;Meier and Schreier, 1976;Schmidt and Fanchamps, 1974) but using this method it is not possible to distinguish between the parent drug and its metabolites. The authors have previously reported (Orton, 1978) the measurement of ergotamine in plasma by radio-immunoassay and they now report a pharmacokinetic study in subjects given ergotamine by the i.v., i.m., oral and rectal routes, with preliminary observations on the relationship between toxic effects and plasma concentrations.

We present a patient with a non-IgE-mediated urticaria reaction to the morphine injection which was tinted blue due to prior injection of Patent Blue V dye into her left breast. Clinicians should be aware of these types of reaction to morphine. K E Y W O R D Sdirect histamine release, morphine injection, non-IgE-mediated localized reaction, Patent Blue V F I G U R E 1 Localized blue wheals following morphine injection on the right arm 924 | KOUMAKI And ORTOn erythema, pruritus, and sometimes pseudoallergic anaphylactoid reactions. 1,2 In our case, the patient experienced a non-IgE-mediated urticarial reaction to the morphine injection which was tinted blue due to prior subareolar injection of Patent Blue V dye into her left breast.

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