Among patients treated concomitantly with ergotamine and propranolol a few cases of vasospastic reactions have been reported. Some cases of ergotamine poisoning have been reported in patients who have taken less than 5 mg of the drug. Usually, however, toxicity is seen in doses of ergotamine tartrate in excess of about 15 mg in 24 hours or 40 mg in a few days. The symptoms of ergotamine poisoning include cold, pale and numb extremities, muscle pain both with and without activity, decreased or even obliterated peripheral pulses and gangrene of the fingers and toes. Other symptoms of ergotism may occur including anginal pain, tachycardia, bradycardia, hypotension or hypertension, headache, nausea, vomiting, diarrhea, itching, formication, anal burning, weakness, miosis, confusion, depression, drowsiness and possible unconsciousness, increase in muscle tone with pain and trismus, and rarely convulsions and hemiplegia.
Respiratory depression can also occur.
Overdosage is particularly likely to occur in patients with sepsis or impaired renal or hepatic function. Patients with peripheral vascular disease are specially at risk of developing peripheral ischemia following treatment with ergotamine. Includes withdrawal and elimination of the offending drug and symptomatic therapy. Do not attempt gastric lavage on an unconscious patient unless cuffed endotracheal intubation has been performed to prevent aspiration and pulmonary complications. There is no evidence that forced diuresis accelerates elimination of ergotamine.