Methysergide Ergot derivatives

The multiple pharmacological effects of ergot alkaloids complicate determination of their precise mechanism of action in the acute treatment of migraine. Actions of ergot alkaloids at 5-HTj jj receptors likely mediate their acute antimigraine effects. The ergot derivative methysergide. 

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... 

ERGOT DERIVATIVES MACROLIDES, QUINU-PRISTIN/DALFOPRISTIN, t ergotamine/methysergide levels with risk of toxicity Inhibition of CYP3A4-mediated metabolism of the ergot derivatives Avoid co-administration... 

ERGOTAMINE, METHYSERGIDE 5-HT1 AGONISTS-TRIPTANS T risk of vasospasm Additive effect 1. Do not administer ergotamine and almotriptan, rizatriptan, sumatriptan or zolmitriptan within 6 hours of each other 2. Do not administer methy-sergide and almotriptan, rizatriptan, sumatriptan or zolmitriptan within 24 hours of each other 3. Do not administer an ergot derivative and eletriptan orfrovatriptan within 24 hours of each other... 

Clinically important, potentially hazardous interactions with alprazolam, astemizole, clindamycin, darunavir, dasatinib, dihydroergotamine, eplerenone, ergot derivatives, fentanyl, garlic, ixabepilone, ketoconazole, lapatinib, methysergide, midazolam, phenytoin, pimozide, rifampin, ritonavir, sildenafil, solifenacin, St John s wort, temsirolimus, tolvaptan... 

As might be expected, other semisynthetic ergot derivatives, such as methysergide (Fig. 10-9) and 2-bromo-LSD, act similarly. Other unrelated structures that have antitryptamin-ergic (antiserotoninergic) actions while simultaneously exhibiting other unrelated actions are cyproheptadine and ketanserin. 

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