Triptans Ergotamine

Besides the classical ergotamine/macrolide interaction, attention has been focused on the DHE/triptan interaction with risk of acute vasoconstriction (this raises the difficult question of the acute treatment in patients taking a long term preventive regimen). 

Administered orally, ergotamine and sumatriptan have only limited bioavailability. Dihydroergotamine may be given by i.m. or slow i.v. injection, sumatriptan subcutaneously, by nasal spray, or as a suppository. When given orally, other triptans such as zolmitriptan, naratriptan, and rizatriptan have higher bioavailability than sumatriptan. 

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... 

Ergotamine 1-2 mg as a suppository is used if other treatments have failed, but not within 12 h of the last dose of a triptan similarly a triptan should not be given until 24 h have elapsed after stopping ergotamine. 

Headaches Triptans, ergotamines, NSAIDS, opiates, Sedation, chest pain, tingling/numbness. 

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