Ergotamine Beta blockers

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. 

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... 

Aortic and mitral valvular fibrosis can lead to congestive cardiac failure fibrosis rarely affects the endocardium more extensively (extending into the myocardium) or the pericardium (resulting in constrictive pericarditis). Vasospastic effects can occasionally be as severe in susceptible subjects as with ergotamine especially dangerous are combinations with ergotamine tartrate, as are combinations of ergot alkaloids with beta-blockers (SEDA-9,128). 

Clinically important, potentially hazardous interactions with albuterol, alpha-blockers, amitriptyline, amoxapine, atenolol, beta-blockers, carteolol, chlorpromazine, clomipramine, cocaine, desipramine, doxepin, ephedra, ergotamine, furazolidone, halothane, imipramine, insulin detemir, MAO inhibitors, metoprolol, nadolol, nortriptyline, oxprenolol, penbutolol, phenelzine, phenoxybenzamine, phenylephrine, pindolol, prazosin, propranolol, protriptyline, sympathomimetics, terbutaline, thioridazine, timolol, tranylcypromine, tricyclic antidepressants, trimipramine, vasopressors... 

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