Ergot derivatives Beta blockers

BETA-BLOCKERS ERGOT DERIVATIVES Three reported cases of arterial vasoconstriction and one of T BP occurred when ergotamine or methysergide was added to propanolol or oxprenolol Ergotamine can cause peripheral vasospasm, and absence of beta-adrenergic activity can t the risk of vasoconstriction Ergot derivatives and beta-blockers are often co-administered without trouble however, monitor BP at least weekly until stable (watch for t BP) and warn patients to stop the ergot derivative and seek medical attention if they develop cold, painful feet... 

Ergotamine is an ergot alkaloid derivative indicated in the treatment of migraine. Propranolol (a fat-soluble and therefore centrally active beta-blocker) and amitriptyline (tricyclic antidepressant) are used for the prophylaxis of migraine headache. 

Uncertain. One suggestion is that additive vasoconstriction occurs. - Ergot derivatives eause vasoconstriction, and the beta blockers do the same by blocking the normal (beta2-stimulated) sympathetic vasodilatation. The beta blockers also reduce blood flow by reducing cardiac output. 

The use of beta blockers with ergot derivatives in the management of migraine is not uncommon, but concurrent use has resulted in three cases of severe peripheral vasoconstriction and one of hypertension. 

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