Ergotamine/Caffeine (Cafergot, Migergot): Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

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Overview: Ergotamine/caffeine is used to treat certain types of headaches, such as migraine or cluster headache. It works by reducing pain and inflammation that come with these headaches. Common side effects may include increased blood pressure, temporary heart rate changes, nausea, vomiting, numbness and tingling, weakness, and feeling off balance. Ergotamine/caffeine comes as a tablet that is swallowed and a suppository that is inserted into the rectum.

Uses

What is ergotamine/caffeine used for?

Ergotamine/caffeine is commonly used to treat certain types of headaches, such as migraine, certain types of migraine (such as vestibular migraine or ocular migraine), or cluster headache.

Ergotamine/caffeine may also be used for other conditions as determined by your health care provider.

How does ergotamine/caffeine work (mechanism of action)?

Migraine and cluster headaches likely have different causes, but both may involve a widening of blood vessels in the brain, which leads to pain and inflammation. There may also be changes in brain chemicals, such as serotonin. Ergotamine/caffeine contains two ingredients: ergotamine and caffeine.

Ergotamine works by narrowing these blood vessels and blocking certain serotonin receptors to relieve pain and inflammation.
Caffeine also helps narrow blood vessels without needing a higher dose of ergotamine.

How is ergotamine/caffeine supplied (dosage forms)?

Brands and other names

Cafergot
Migergot

Dosage forms and strengths

1 mg/100 mg oral tablets
2 mg/100 mg rectal suppositories

How should I store ergotamine/caffeine?

Oral Tablet. Ergotamine/caffeine tablets should be stored at room temperature, between 68 F and 77 F (20 C and 25 C). They can be exposed to temperatures between 59 F and 86 F (15 C and 30 C) for shorter periods of time, such as when you’re transporting them. Store them in a cool, dry place, and protect them from light and heat.

Rectal Suppository. Ergotamine/caffeine rectal suppositories should be stored in the refrigerator, between 36 F and 46 F (2 C and 8 C).

Side Effects

What are the most common side effects of ergotamine/caffeine?

The most common side effects of ergotamine/caffeine are listed below. Tell your health care provider if you have any of these side effects that bother you.

Increased blood pressure (see below)
Temporary changes in heart rate
Nausea and vomiting
Numbness, tingling, or burning in your arms, feet, or face
Weakness
Feeling off balance

There may be other side effects of ergotamine/caffeine that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of ergotamine/caffeine?

While less common, the most serious side effects of ergotamine/caffeine are described below, along with what to do if they happen.

Severe Allergic Reactions. Ergotamine/caffeine may cause allergic reactions, which can be serious. Stop using ergotamine/caffeine and get help right away if you have any of the following symptoms of a serious allergic reaction.

Breathing problems or wheezing
Racing heart
Fever or general ill feeling
Swollen lymph nodes
Swelling of the face, lips, mouth, tongue, or throat
Trouble swallowing or throat tightness
Itching or skin rash
Bumps on the skin called hives that can be red, pink, white, or brown, depending on your skin tone
Nausea or vomiting
Dizziness, feeling lightheaded, or fainting
Stomach cramps
Joint pain

Heart Attack, Other Heart Problems, and Stroke. Ergotamine/caffeine may increase your risk of heart attacks, other heart problems (such as a fast or slow heart rate or an abnormal heart rhythm), or strokes, which can lead to death. Stop using ergotamine/caffeine and get emergency help if you have any of the following symptoms.

Chest pain, pressure, or tightness
Fast, slow, or abnormal heartbeat
Trouble breathing
Pain in your back, neck, jaw, throat, or stomach
Unusual sweating
Nausea or vomiting
Feeling dizzy or lightheaded
Weakness or numbness on one side of your body
Loss of vision in one or both eyes
Sudden, severe headache with no known cause
Slurred speech or trouble understanding speech

Blood Flow Problems. Ergotamine/caffeine may reduce blood flow to many areas of the body, which can be serious. Stop using ergotamine/caffeine and tell your health care provider right away if you have any of the following symptoms.

Tingling, numbness, or a change in the color of your fingers or toes
Muscle pain or weakness
Sudden or severe stomach pain
Weight loss
Constipation or diarrhea
Nausea or vomiting

Increased Blood Pressure (Hypertension). Ergotamine/caffeine may increase your blood pressure or make it worse if you have a history of high blood pressure. Call your health care provider if your blood pressure increases while you’re using this medicine.

If you measure your blood pressure and the top number (systolic) is 180 mm Hg or higher or the bottom number (diastolic) is 120 mm Hg or higher, get medical attention right away. Increases in blood pressure may not be noticeable, but look out for any of the following symptoms of severely high blood pressure and tell your health care provider right away if you have them.

Sudden severe headache
Chest pain
Dizziness or confusion
Trouble breathing
Nausea or vomiting
Blurry vision or other changes to vision
Anxiety
Buzzing in the ears
Nosebleed
Feeling of skipped heartbeats

Medicine Overuse Headache. Using too much ergotamine/caffeine may cause your headaches to happen more often or to get worse. This is called a medicine overuse headache or a rebound headache. If you notice that your headaches happen more often than before or are getting worse, contact your health care provider.

Tissue Changes. Ergotamine/caffeine may rarely cause a buildup of scar tissue and inflammation around the lungs, stomach, or other organs, which is called fibrosis. This can happen in people using this medicine long-term. Do not use more medicine than prescribed or use it daily long-term. Tell your health care provider if you have any symptoms that concern you.

Warnings & Precautions

Who should not use ergotamine/caffeine?

Allergies to Ingredients. People who are allergic to any of the following should not use ergotamine/caffeine.

Cafergot
Caffeine
Ergotamine
Migergot
Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific ergotamine/caffeine products they stock.

Pregnancy. Do not use ergotamine/caffeine if you are pregnant or may become pregnant. If you become pregnant, contact your health care provider right away. See the Pregnancy section for more details.

Drug Interactions. Ergotamine/caffeine should not be used while you are using certain other medicines because it may increase the risk of severe blood flow problems and possibly a stroke or death. Before using ergotamine/caffeine, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Heart Problems or High Blood Pressure. Ergotamine/caffeine should not be used if you have high blood pressure (hypertension) or certain heart problems, such as coronary artery disease. Tell your health care provider if you have these conditions.

Blood Vessel Problems. Ergotamine/caffeine should not be used if you have certain problems with your arteries or veins (peripheral vascular disease). Tell your health care provider if you have any problems with your blood vessels.

Kidney Problems. Ergotamine/caffeine should not be used if your kidneys are not working as well as they should be. If there is a concern about the health of your kidneys, your health care provider may do tests to see if they are working well enough for you to use this medicine.

Liver Problems. Ergotamine/caffeine should not be used if your liver is not working as well as it should be. If there is a concern about the health of your liver, your health care provider may do tests to see if it is working well enough for you to use this medicine.

Sepsis. Ergotamine/caffeine should not be used if you have sepsis. Sepsis is a life-threatening problem that can happen when your immune system overreacts to an infection and causes organ damage.

What should I know about ergotamine/caffeine before using it?

Do not use ergotamine/caffeine unless it has been prescribed to you by a health care provider. Use it as prescribed. Overusing ergotamine/caffeine can cause serious side effects. Overusing the suppository may increase the risk of open sores in the rectal or anal area.

Do not share ergotamine/caffeine with other people, even if they have the same condition as you. It may harm them.

Keep ergotamine/caffeine out of the reach of children. Since the suppositories should be kept in a refrigerator, take special precautions to keep this medicine away from children who also use the refrigerator.

There are multiple forms of ergotamine/caffeine available. Read and follow the instructions for the product you have, and make sure you understand how to use it properly. If you have any questions, talk to your health care provider. If you have nausea and vomiting during a headache and are unable to take any medicines by mouth, your health care provider may prescribe the suppository form.

The suppository is inserted into the rectum. The suppositories are wrapped in foil. If the suppository becomes soft due to heat, place it in ice-cold water to harden it again before you remove it from the foil. Unwrap the suppository before inserting it.

It may be helpful to keep a headache journal where you write down when you get your headaches and when you use ergotamine/caffeine. This information could be shared with your health care provider to see how the medicine is working for you.

Ergotamine/caffeine works better if it’s used at the first sign of an attack. It is not for long-term daily use. Do not use more than the recommended dose. For the tablets, do not take more than six tablets for a single attack or more than 10 tablets within a seven-day period. For the suppositories, do not use more than two suppositories for a single attack or more than five suppositories within a seven-day period. Ask your health care provider if you have any questions.

Some ergotamine/caffeine products may contain an ingredient called FD&C Yellow No. 5, also called tartrazine. Some people who have an allergy to aspirin may also be allergic to tartrazine.

What should I tell my health care provider before using ergotamine/caffeine?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if ergotamine/caffeine is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your health care provider if you have any of the following.

Heart problems or a history of heart problems
High blood pressure
Risk factors for heart disease, such as high cholesterol, smoking, diabetes, or a family history of heart disease
Kidney or liver problems
Blood flow problems, including peripheral vascular disease or Raynaud’s syndrome
Stomach or intestine problems

Smoking or Nicotine Use. Nicotine (which can be found in cigarettes, vapes, or products that help you stop smoking) may increase the risk of side effects from ergotamine/caffeine. Tell your health care provider if you smoke or use any of these products.

Pregnancy. Ergotamine/caffeine may cause preterm labor and should be avoided during pregnancy. Tell your health care provider right away if you are pregnant or plan to become pregnant.

Breastfeeding. Ergotamine/caffeine passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will let you know if you should stop breastfeeding or stop ergotamine/caffeine.

Interactions

Does ergotamine/caffeine interact with foods or drinks?

Ergotamine/caffeine may interact with grapefruit or grapefruit juice. Tell your health care provider if you eat grapefruit or drink grapefruit juice before using ergotamine/caffeine.

It is unknown if drinking alcohol will affect ergotamine/caffeine. For some people, alcohol can trigger headaches. Talk to your health care provider if you drink alcohol.

Does ergotamine/caffeine interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using ergotamine/caffeine.

A macrolide antibiotic, such as clarithromycin or erythromycin (Ery-Tab and others), which is a medicine used for bacterial infections
Clotrimazole, fluconazole (Diflucan), itraconazole (Sporanox, Tolsura), ketoconazole, posaconazole (Noxafil), or voriconazole (Vfend), which are medicines used for fungal infections
Metronidazole (Flagyl and others), which is a medicine commonly used to treat bacterial and other infections
A protease inhibitor, such as atazanavir (Reyataz), nelfinavir (Viracept), or ritonavir (Norvir), which is a medicine commonly used to treat HIV
Any other ergot, such as dihydroergotamine (Migranal, Trudhesa) or ergotamine (Ergomar), which is a medicine used to treat migraine
A beta-blocker, such as atenolol (Tenormin), metoprolol (Lopressor, Toprol XL, and others), or propranolol (Inderal LA, Innopran XL), which is a medicine that may be used for certain heart conditions or to lower blood pressure
A vasoconstrictor, such as pseudoephedrine, which is a medicine that may be used for nasal congestion and can cause blood vessels to narrow
Nefazodone, which is a medicine used to treat depression
Fluoxetine, which is a medicine commonly used for anxiety and depression
Fluvoxamine (Luvox), which is a medicine commonly used for obsessive-compulsive disorder (OCD)
Zileuton (Zyflo), which is a medicine commonly used for asthma

Many other medicines may alter the blood levels of ergotamine/caffeine. Tell your health care provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with ergotamine/caffeine. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much ergotamine/caffeine?

If you or someone else has used too much ergotamine/caffeine, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.