Ergotamine and Caffeine (patient information)

# IMPORTANT WARNING
Do not take ergotamine and caffeine if you are taking antifungals such as itraconazole (Sporanox) and ketoconazole (Nizoral); clarithromycin (Biaxin); erythromycin (E.E.S., E-Mycin, Erythrocin); HIV protease inhibitors such as indinavir (Crixivan), nelfinavir (Viracept), and ritonavir (Norvir); or troleandomycin (TAO).

# Why this medication is prescribed
The combination of ergotamine and caffeine is used to prevent and treat migraine headaches. Ergotamine is in a class of medications called ergot alkaloids. It works together with caffeine by preventing blood vessels in the head from expanding and causing headaches.

# How this medication should be used
The combination of ergotamine and caffeine comes as a tablet to take by mouth and as a suppository to insert rectally. It is usually taken at the first sign of a migraine headache. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ergotamine and caffeine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
To use the tablets, follow these steps:
- Take two tablets at the first sign of a migraine.
- Lie down and relax in a quiet, dark room for at least 2 hours.
- If the headache pain does not stop within 30 minutes, take one or two more tablets.
- Take one or two tablets every 30 minutes until the headache pain stops or you have taken six tablets.
- If the headache pain continues after you have taken six tablets, call your doctor. Do not take more than six tablets for one headache unless your doctor specifically tells you to do so.
- Do not take more than six tablets in 24 hours or 10 tablets in 1 week. If you need more, call your doctor.
To use the suppositories, follow these steps:
- If the suppository feels soft, place it in ice cold water (before removing foil wrapper) until it hardens.
- Remove the wrapper and dip the tip of the suppository in water.
- Lie down on your left side and raise your right knee to your chest. (A left-handed person should lie on the right side and raise the left knee.)
- Using your finger, insert the suppository into the rectum, about 1/2 to 1 inch in children and 1 inch in adults. Hold it in place for a few moments.
- Wash your hands thoroughly; then lie down and relax in a dark, quiet room for at least 2 hours.
- If the headache pain does not stop within 1 hour, insert another suppository.
- If the headache pain continues after you have inserted two suppositories, call your doctor. Do not use more than two suppositories for one headache unless your doctor specifically tells you to do so.
- Do not use more than five suppositories in 1 week. If you need more, call your doctor.

# Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

# Special precautions
Before taking ergotamine and caffeine:
- tell your doctor and pharmacist if you are allergic to ergotamine, caffeine, or any other medications.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention the medications listed in the IMPORTANT WARNING section and any of the following: clotrimazole, fluconazole (Diflucan), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), medications for asthma and colds, metronidazole (Flagyl), nefazodone (Serzone), propranolol (Inderal), saquinavir (Invirase, Fortovase), and zileuton (Zyflo). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have or have ever had high blood pressure; problems with circulation; coronary artery disease; a severe blood infection; or kidney or liver disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking ergotamine and caffeine, call your doctor immediately. Ergotamine and caffeine may harm the fetus.

# Special dietary instructions
Talk to your doctor about drinking grapefruit juice while taking this medicine.

# Side effects

## Minor side effects
Ergotamine and caffeine may cause side effects. Tell your doctor if either of these symptoms is severe or does not go away:
- upset stomach
- vomiting

## Severe side effects
Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:
- leg weakness
- chest pain
- rapid heartbeat
- slow heartbeat
- dizziness
- muscle pain in the legs or arms
- blue hands and feet
- swelling
- itching
- pain, burning, or tingling in the fingers and toes
Ergotamine and caffeine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# Storage conditions needed for this medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature, away from light and excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include:
- vomiting
- numbness
- tingling sensation
- pain
- blue hands and feet
- lack of pulse
- dizziness or lightheadedness
- fainting
- drowsiness
- unconsciousness
- coma
- seizures

# Other information
Keep all appointments with your doctor.
If you take large doses of this medication for a long time, you may have a severe headache for a few days after stopping the medication. If the headache lasts for more than a few days, call your doctor.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Cafatine
- Cafergot
- Cafetrate
- Ercaf
- Ergo-Caff
- Migergot
- Wigraine

# Other names
- Caffeine-Ergotamine