Ergotamine, Dihydroergotamine: Current Uses and Problems

Abstract

In randomized clinical trials oral ergotamine was found superior to placebo but inferior to oral sumatriptan 100mg. In contrast rectal ergotamine was found to have higher efficacy (73% headache relief) than rectal sumatriptan (63% headache relief). Intranasal dihydroergotamine (DHE) was found superior to placebo but less effective than subcutaneous and intranasal sumatriptan. In general, the use of the more specific drugs, the triptans, causing less adverse events and being more effective, is preferable to the use of the ergotamine in the acute treatment of migraine. If ergotamine is to be used the rectal route is preferable. The rectal dose of ergotamine should be tailored to the individual patient. The intranasal dose of DHE , between 1 and 2 mg, should also be tailored to the individual patient. In order to avoid drug-induced headache ergotamine and DHE should not be used daily.

A Randomized Prospective Placebo-Controlled Study of Intravenous Magnesium Sulphate vs. Metoclopramide in the Management of Acute Migraine Attacks in the Emergency Department

“…The recurrence rate of pain within 24 h in all three patient groups was about 50% in our study. Similarly high recurrence rates have been found in studies with either magnesium (16) or combinations of other drugs such as sumatriptan, aspirin or metoclopramide (31), and lower for ergotamine (32).…”

Reduced Adverse Event Profile of Orally Inhaled DHE (MAP0004) vs IV DHE: Potential Mechanism

“…Typically, DHE is administered by intravenous (IV) injection 6,7 or self‐administered by intranasal delivery 8,9 or intramuscular/subcutaneous injection 10 . Oral DHE is rarely used, because of slow and limited absorption from the gastrointestinal tract and extensive first pass metabolism.…”

“…1 Because of structural homology with other physiological mediators, DHE has a wide range of pharmacological activity that is mediated by its effects on biogenic amine receptors, specifically serotonergic (5-HT) subtypes, adrenergic (a and b) subtypes, and dopaminergic (D) subtypes 2 including effects on 5-HT1B receptors to constrict intracranial extracerebral blood vessels and on 5-HT1D receptors to inhibit trigeminal neurotransmission. [3][4][5] Typically, DHE is administered by intravenous (IV) injection 6,7 or self-administered by intranasal delivery 8,9 or intramuscular/subcutaneous injection. 10 Oral DHE is rarely used, because of slow and limited absorption from the gastrointestinal tract and extensive first pass metabolism.…”

Is the Generally Held View That Intravenous Dihydroergotamine Is Effective in Migraine Based on Wrong “General Consensus” of One Trial? A Critical Review of the Trial and Subsequent Quotations

“…According to a search on Google Scholar on April 26, 2015, the study by Callaham and Raskin has been cited 153 times. However, a control with hand counting resulted in 150 citations, 111 of which were retrieved and included , . Three citations were ordered from the library system, but were not retrieved.…”