ergotamine / caffeine
Cafergot (ergotamine / caffeine) is used to treat cluster headaches and migraines in adults. It's available as a tablet that's taken by mouth, as well as a suppository that's inserted into the rectum. Typically, you take a dose as soon as you feel a headache coming on. But there's a limit to how many doses you can take each week because taking this medication too often can lead to serious side effects, such as vomiting and numbness. Brand name Cafergot is discontinued.
What is Cafergot (ergotamine / caffeine)?
What is Cafergot (ergotamine / caffeine) used for?
- Headache pain caused by swollen or widened blood vessels (vascular headaches)
How Cafergot (ergotamine / caffeine) works
Cafergot (ergotamine / caffeine) is a combination of two medications. Ergotamine (an ergot derivative) and caffeine (a nonselective PDE inhibitor) tighten blood vessels and calm certain parts of the brain to relieve the pain of your headaches.
Drug facts
Side effects of Cafergot (ergotamine / caffeine)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Nausea
Less Common Side Effects
- Vomiting
- Heart-related chest pain
- Muscle pain
- Fast or slow heartbeat
- High blood pressure
- Tingling
- Numbness
- Weakness
- Sensation of room spinning
- Swelling from fluid buildup
- Itching
- Rectal ulcers (suppository only)
Cafergot (ergotamine / caffeine) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Stroke: weakness on one side of your body, slurred speech, drooping face
- Poor blood flow to the hands or feet: pain, numbness, coldness, or pale color in the hands or feet
The following Cafergot (ergotamine / caffeine) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Burning, pain, tingling, or color changes in the hands, arms, legs, or feet
- Dry cough, shortness of breath or trouble breathing
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- Increase in blood pressure
- Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
- Sudden or severe stomach pain, bloody diarrhea, fever, nausea, vomiting
- Pain in the lower back or sides
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
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Pros and cons of Cafergot (ergotamine / caffeine)
Pros
- Suppository is a good option for people who've trouble swallowing pills
- Tablet is available as a lower-cost generic
- Can start to feel relief after a half hour (for the tablets) or an hour (for the suppository); and you may take an additional dose if no relief
Cons
- Not for daily or long-term use
- Can't take while pregnant
- Not safe for use for people with kidney or liver problems
- Rectal suppository is brand name only and requires refrigeration
Pharmacist tips for Cafergot (ergotamine / caffeine)
- Take Cafergot (ergotamine / caffeine) as soon as you feel a headache or migraine coming on. Since these attacks can happen anywhere, it's a good idea to carry Cafergot (ergotamine / caffeine) with you at all times, especially if you have the tablet form (the suppository needs to be kept in the refrigerator).
- Take Cafergot (ergotamine / caffeine) exactly as prescribed and only when needed. Don't take it for long periods of time since this can lead to serious side effects, including blood circulation problems. Taking Cafergot (ergotamine / caffeine) long term can also cause your body to become dependent on it and can even cause rebound headaches.
- Take the tablet with or without food. Food won't affect how well this medication works to treat your headache.
- If you're using the suppository, store them in the refrigerator. Make sure to remove the foil wrapper before inserting it rectally. Insert the pointed end first. Try to use the medication as soon as you take it out, before it starts to melt.
- Cafergot (ergotamine / caffeine) is known to cause birth defects. Don't take this medication if you're pregnant or think you may be pregnant. If necessary, use a good form of birth control to prevent accidental pregnancy.
- If you're breastfeeding, don't take Cafergot (ergotamine / caffeine). Ergotamine can pass into your breast milk and cause side effects, such as vomiting, diarrhea, weak pulse, and unstable blood pressure, in your baby.
- Cafergot (ergotamine / caffeine) works similarly to triptan medications, like sumatriptan (Imitrex) or rizatriptan (Maxalt), and has very similar side effects. Taking them at the same time can lead to dangerously high blood pressure and other serious side effects. Don't take these medications together or within 24 hours of each other.
- Don't take Cafergot (ergotamine / caffeine) if you have heart disease or blood vessel problems because it can worsen your condition. Make sure to tell your healthcare team about your full medical history before starting this medication.
- Certain medications can affect the levels of Cafergot (ergotamine / caffeine) in your body and raise your risk of side effects. Make sure your healthcare team and pharmacist know all of the medications that you take, so they can help you watch out for dangerous drug interactions.
- If you're taking Cafergot (ergotamine / caffeine), it's best to avoid other forms of caffeine such as coffee, tea, or energy drinks. One tablet or suppository contains 100 mg of caffeine, which is about the amount of caffeine in one cup of coffee.
Common questions about Cafergot (ergotamine / caffeine)
Cafergot (ergotamine / caffeine) isn't available over the counter; ask your healthcare professional if this medication is right for you, and they can write you a prescription for it.
Research suggests that caffeine helps relieve pain from headaches by tightening blood vessels in the brain. In addition, it's thought that caffeine help the body better absorb ergotamine, as well as other pain medications. So when caffeine is combined with ergotamine, you'll experience greater pain relief from ergotamine without needing to take a higher dose. This lowers your risk of serious side effects from ergotamine, such as nausea, numbness, and weakness.
No, don't take Cafergot (ergotamine / caffeine) during pregnancy because there's a risk that it can cause harm to your unborn baby. Talk with your obstetrician gynecologist (Ob-Gyn) provider about what's safe for you to take for your headaches during pregnancy.
An older study comparing oral sumatriptan (Imitrex) and oral Cafergot (ergotamine / caffeine) showed that more people experienced headache relief from sumatriptan (Imitrex) than from Cafergot (ergotamine / caffeine) 2 hours after the dose. In addition, sumatriptan (Imitrex) eased pain more quickly than Cafergot (ergotamine / caffeine). But people who took Cafergot (ergotamine / caffeine) experienced less repeat headaches after 2 days, compared to those who took sumatriptan (Imitrex). Talk with your healthcare professional about the best headache treatment for you.
Ask your primary care provider if it's appropriate for you to take Cafergot (ergotamine / caffeine) and ibuprofen (Advil). While there's no major interaction between these medications, it doesn't mean this combination is appropriate for everyone. For example, taking higher doses of ibuprofen (Advil) can raise your risk of nausea and high blood pressure, which are also side effects of Cafergot (ergotamine / caffeine).
You're unlikely to experience rebound headaches if you take Cafergot (ergotamine / caffeine) as prescribed. Rarely, people have reported rebound headaches after stopping Cafergot (ergotamine / caffeine), especially if they've been taking this medication more often than recommended over a longer period of time. Talk with your primary care provider if you're concerned about rebound headaches.
Cafergot (ergotamine / caffeine) doesn't usually make people feel drowsy or sleepy, especially since it contains caffeine. Talk to your provider if you experience drowsiness from this medication.
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Risks and warnings for Cafergot (ergotamine / caffeine)
Cafergot (ergotamine / caffeine) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Dangerously low blood flow to your brain and limbs
- Risk factors: Taking macrolide antibiotics or protease inhibitors | Taking more Cafergot (ergotamine / caffeine) than prescribed
Certain medications can raise the levels of Cafergot (ergotamine / caffeine) in your body. Higher levels can make your blood vessels too narrow and affect blood flow to your brain (which can cause a stroke) or hands and feet (which can cause tissue death). Don't take Cafergot (ergotamine / caffeine) with protease inhibitors (which are usually used for HIV) or macrolide antibiotics, such as erythromycin (Ery-Tab) or clarithromycin. There are several other medications that have the potential to raise Cafergot (ergotamine / caffeine) levels in your body. Examples of these include nefazodone (Serzone), fluoxetine (Prozac), and metronidazole (Flagyl). Let your healthcare team and pharmacist know all of the medications that you take, so they can make sure your medications are safe to take together. Get medical help right away if you have pain in your hands or feet, numbness, coldness, or if you're pale in color. Call 911 if you have any symptoms of a stroke, such as weakness on one side of your body, slurred speech, and drooping face.
Fibrosis (scarring)
- Risk factors: Taking Cafergot (ergotamine / caffeine) daily or for a long period of time
In some rare cases, people have experienced fibrosis (scarring) in their stomach, lungs, or heart after taking Cafergot (ergotamine / caffeine). Take Cafergot (ergotamine / caffeine) only as needed. If you find that you need to take this medication every day, talk to your care team about alternative treatment options for your headaches.
Allergic reaction to yellow dye
- Risk factors: Allergy to aspirin
Cafergot (ergotamine / caffeine) tablets contain yellow #5 dye, which is also known as tartrazine. Although rare, tartrazine can cause allergic reactions, such as airway tightening and difficulty breathing. Talk to your healthcare professional or pharmacist if you have an allergy to tartrazine or yellow dye.
Cafergot (ergotamine / caffeine) dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 1mg/100mg | 30 tablets | $112.30 | $3.74 |
Typical dosage for Cafergot (ergotamine / caffeine)
- Oral tablet: Each tablet contains 1 mg of ergotamine and 100 mg of caffeine. The typical dose is 2 tablets by mouth as soon as you feel a headache coming on. Take 1 more tablet every 30 minutes as needed. Don't take more than 6 tablets per headache episode or more than 10 tablets per week.
- Rectal suppository (Migergot): Each suppository contains 2 mg of ergotamine and 100 mg of caffeine. The typical dose is 1 suppository inserted rectally as soon as you feel a headache coming on. Take 1 more suppository after 1 hour if you need more relief. Don't use more than 2 suppositories per headache episode or more than 5 suppositories per week.
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Cafergot (ergotamine / caffeine) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Cafergot (ergotamine / caffeine) will not be safe for you to take.
- Taking medications that raise the levels of Cafergot (ergotamine / caffeine) in your body, such as macrolide antibiotics and protease inhibitors
- Currently pregnant or might become pregnant
- Blood vessel problems in the hands or feet (peripheral vascular disease)
- Heart disease
- High blood pressure
- Liver or kidney disease
- Sepsis (serious complication due to an infection)
What are alternatives to Cafergot (ergotamine / caffeine)?
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