Eletriptan × Ergotamine

Both drugs constrict arteries. Eletriptan stimulates serotonin receptors in the vessel wall, and drugs of this group can cause coronary artery spasm. Ergotamine constricts blood vessels and can cause myocardial ischaemia, or rarely infarction, even in people with no known heart disease. Vasospasm after ergot drugs can be prolonged. In clinical trials, oral ergotamine with caffeine given 1 and 2 hours after eletriptan raised blood pressure only slightly. Still, the effects of the two drugs added up, as their pharmacology predicts.

Coronary artery spasm causes chest pain, pressure or tightness, sometimes severe and spreading to the throat, neck or jaw, and can lead to myocardial infarction. Serious arrhythmias such as ventricular tachycardia and ventricular fibrillation have been reported within a few hours of taking drugs of this group. Vasospasm from ergotamine causes numbness and tingling in the fingers and toes, headache and pain over the heart. With severe spasm, the limbs turn blue and their pulses disappear. Spasm of the intestinal arteries causes abdominal pain with bloody diarrhoea, and spasm of the finger arteries causes Raynaud's syndrome. In rare cases, blood pressure rises to a hypertensive crisis.

The eletriptan documents of the Spanish Agency of Medicines and Medical Devices (AEMPS) and the US Food and Drug Administration (FDA) contraindicate the combination. The Spanish summary of product characteristics (SmPC) for ergotamine with caffeine contraindicates all triptans (AEMPS). Keep at least 24 hours between the two drugs, in either order (eletriptan SmPC, AEMPS, and label, FDA). If ergotamine has not stopped the attack, do not add a triptan for the same attack (ergotamine with caffeine SmPC, AEMPS). If chest pain or tightness suggesting cardiac ischaemia appears after an eletriptan dose, give no further doses and evaluate the heart (eletriptan SmPC, AEMPS). Stop ergotamine at once if numbness or tingling in the fingers, pain over the heart or other signs of vasospasm appear (ergotamine with caffeine SmPC, AEMPS). Stop eletriptan if arrhythmias occur, and monitor blood pressure during treatment (eletriptan label, FDA). If abdominal pain with blood in the stool or white fingers appear, rule out vasospasm before the next eletriptan dose (eletriptan label, FDA). Taking ergotamine, triptans or both on 10 or more days a month can cause medication overuse headache, with more frequent attacks (eletriptan label, FDA).