Ergotamine tartrate 2mg / Caffeine 100mg suppositories

This comprehensive literature review addresses the scarcity and limited study of hypotension treatments compared to abundant antihypertensive drugs. Hypotension, categorized as absolute, relative, or orthostatic, has diverse causes. This review explores various treatments, including drugs affecting the sympathetic nervous system, such as midodrine, dihydroergotamine, and ergotamine, which have shown efficacy in managing hypotension. Dopamine agonists/antagonists and other drugs such as ephedrine, norepinephrine, and fludrocortisone are also discussed, each with distinct mechanisms and applications. Additionally, adjunctive agents such as non-steroidal anti-inflammatory agents, caffeine, and monoamine oxidase inhibitors are reviewed for their effects on blood pressure. This review underscores the importance of understanding the efficacy and safety profiles of hypotension treatments to guide healthcare professionals in optimal drug selection and management, emphasizing the need for further research and comparative studies for evidence-based guidelines.

Abstract licence: CC BY

This study presents a new method for simultaneously quantifying a complex anti-migraine formulation containing five components (ergotamine, propyphenazone, caffeine, camylofin, and mecloxamine) using UV spectrophotometry and chemometric models. The formulation presents analytical challenges due to the wide variation in component concentrations (ERG: PRO: CAF: CAM: MEC ratio of 0.075:20:8:5:4) and highly overlapping UV spectra. To create a comprehensive validation dataset, the Kennard-Stone Clustering Algorithm was used to address the limitations of arbitrary data partitioning in chemometric methods. Three different chemometric models were evaluated: Classical Least Squares (CLS), Partial Least Squares (PLS), and Multivariate Curve Resolution-Alternating Least Squares (MCR-ALS). Among these, MCR-ALS demonstrated excellent performance, achieving recovery values of 98–102% for all components, accompanied by minimal root mean square errors of calibration (0.072–0.378) and prediction (0.077–0.404). Moreover, the model exhibited high accuracy, with relative errors ranging from 1.936 to 3.121%, bias-corrected mean square errors between 0.074 and 0.389, and a good sensitivity (0.2097–1.2898 μg mL−1) for all components. The Elliptical Joint Confidence Region analysis further confirmed the predictive performance of the models, with MCR-ALS consistently showing the smallest ellipses closest to the ideal point (slope = 1, intercept = 0) for most analytes, indicating superior accuracy and precision. The approach's sustainability was rigorously assessed using six advanced metrics, validating its environmental friendliness, economic viability, and practical application. This approach effectively resolves complex pharmaceutical formulations, contributing to sustainable development objectives in quality control processes.

Abstract licence: CC BY-NC-ND

Research objective: To identify the frequency of opioid use in a group of patients diagnosed with migraine in Colombia. Methods: Study of a retrospective cohort of patients with a diagnosis of migraine and a first prescription of antimigraine drugs from emergency services and a priority outpatient clinic. Sociodemographic, clinical, and pharmacological variables were identified; a 12-month follow-up was carried out to identify the use of a new opioid. Results: A total of 6309 patients with a diagnosis of migraine were identified, with a mean age of 35.5 ± 12.3 years, of which 81.3% were women. Nonsteroidal anti-inflammatory drugs (51.1%) were the most frequently prescribed medications, followed by ergotamine + caffeine (31.3%), acetaminophen (15.05%), and acetaminophen + codeine (14.4%). At the time of the index, 1300 (20.6%) patients received some opioid. During the follow-up, a total of 1437 (22.8%) patients received a new opioid, of which 31.8% belonged to the group that received an initial opioid and 20.4% to the group that did not receive one, which was statistically significant (OR:1.81; 95%CI:1.58–2.07; p < 0.001). Conclusions: The frequent use of opioids in the management of migraines is potentially inappropriate and can lead to problems of tolerance, abuse and dependence. This combined with the low prescription of triptans, offers an opportunity for improvements in medical practice.

Abstract licence: CC BY

Abstract A novel, green, and cost-effective thin-layer chromatography (TLC)‒spectrodensitometric method was designed and validated for the simultaneous determination of a five-component mixture. The analyzed mixture is composed of three active ingredients: propyphenazone (PRO), caffeine (CAF), and ergotamine tartrate (ERG), along with two official impurities which are PRO impurity: phenazone (PHN) and CAF impurity: theophylline (THEO). The suggested method was used for the quantitation of the three coformulated active ingredients in their marketed tablet and in human plasma. The studied compounds were separated on TLC silica gel 60F 254 plates using a mobile phase consisting of methanol–ethyl acetate–glacial acetic acid (1:9:0.1, V/V ) with diprophylline (DPP) as internal standard. Densitometric scanning was carried out at 210.0 nm. Method validation was assessed according to the International Council for Harmonisation (ICH) guidelines. The greenness profile for the proposed method was evaluated using the National Environmental Method Index (NEMI), analytical eco-scale, and Green Analytical Procedure Index (GAPI) tools. The proposed method offers the advantages of being simple, rapid, economic, and ecofriendly. It is a successful choice for the routine analysis of the studied drugs in pharmaceutical and biological samples.

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Spontaneous intracranial hypotension is a condition resulting from cerebrospinal fluid leaks at the spinal level that disrupt the regulation of intracranial pressure. This disorder is an uncommon cause of debilitating headaches but can have variable clinical manifestations, which contributes to delayed diagnosis and potentially severe consequences. The standard treatment consists of conservative measures such as bed rest, hydration, and a pharmacological approach with paracetamol, caffeine, ergotamine, and dexamethasone. When conservative measures fail, an epidural blood patch is the gold standard treatment, where a small amount of blood is injected into the epidural space to form a clot to seal any existing leak. Recent studies showed a success rate of 64% without the need for further intervention. The authors report a case of a 55-year-old woman with a three-month history of daily severe headaches. Imaging exams showed subdural collections, suggesting the hypothesis of cerebrospinal fluid hypotension. After the failure of conservative measures, an epidural blood patch was performed with progressive clinical improvement. This case demonstrates the potential effectiveness of an epidural blood patch in the management of spontaneous intracranial hypotension and its complications, offering an encouraging option for those unresponsive to conservative measures. It also highlights the importance of a multidisciplinary approach involving neurologists and anesthesiologists.

Abstract licence: CC BY

BACKGROUND: Medication-overuse headache (MOH) remains a leading cause of chronic daily headache globally. Although triptans are the predominant implicated in high-income countries, ergotamine continues to be widely used in many low- and middle-income settings. Comparative data on ergotamine- versus triptan-induced MOH remain limited. METHODS: We analyzed prospective data from the Northern Thai Headache Registry, enrolling patients with ergotamine-MOH, triptan-MOH, or dual-MOH. Demographic and clinical characteristics, treatment outcomes, recurrence rates, and withdrawal symptoms were evaluated over 12 months. Outcomes included changes in Headache Impact Test (HIT-6) scores, recurrence-free survival, and adverse events during withdrawal. RESULTS: A total of 117 MOH patients were included: 61 (52.1%) with ergotamine-MOH, 44 (37.6%) with triptan-MOH, and 12 (10.3%) with dual-MOH. Patients with ergotamine-MOH experienced significantly more withdrawal symptoms compared to those with triptan-MOH (P < 0.01). In contrast, recurrence rates were highest among dual-MOH patients (P < 0.01). Improvement in HIT-6 scores was observed across all groups, though ergotamine-MOH patients showed slower recovery trajectories. Kaplan-Meier analysis demonstrated a higher risk of recurrence in dual-MOH compared to single-agent MOH. CONCLUSIONS: Ergotamine-induced MOH is linked to more severe withdrawal symptoms, whereas dual-MOH carries the greatest risk of recurrence. These findings highlight the importance of tailored withdrawal strategies and close monitoring, particularly in resource-limited settings where ergotamine remains widely available. They also support policy initiatives aimed at restricting over-the-counter ergotamine and expanding access to safer acute treatment options.

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Ergotism is a rare but potentially serious condition characterised by peripheral vasospasm. Its diagnosis is challenging because the presentation varies depending on the type and location of the affected blood vessels. Ergot alkaloids, including ergotamine, are metabolised by the cytochrome P450 isoenzyme CYP3A4. Concurrent use of ergotamine with CYP3A4 inhibitors can significantly increase the risk of ergotism. However, this potentially dangerous drug interaction is often underestimated in general practice. Herein, we report the case of a middle- aged woman with a history of migraine headaches, who was treated with Cafergot (ergotamine tartrate and caffeine). After the initiation of human immunodeficiency virus therapy with Kaletra (lopinavir/ritonavir), she experienced recurrent episodes of bluish discoloration, livedo reticularis and tingling sensation in her upper and lower extremities over several years. Despite multiple hospital visits and extensive diagnostic workups, including normal blood investigations and biopsy, the correct diagnosis of ergotism-induced vasospasm due to ritonavir-ergotamine interaction was delayed. This diagnosis was supported by CT angiography, which demonstrated vasospasm of the femoral arteries. The patient's symptoms significantly resolved following ergotamine discontinuation. Ergotism is a self-limiting condition that can be fatal if not recognised and treated promptly. This case highlights the importance of awareness, particularly in primary care settings, on the potential drug interaction, principally in patients receiving drugs that inhibit CYP3A4, such as protease inhibitors. Clinicians should have a low threshold for suspecting ergotism in patients with recurrent or unexplained limb pain, numbness and skin changes, especially if they have a history of ergot alkaloid use.

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Medication-overuse headache (MOH) was first described in 1951 with ergotamine overuse. Since then, much has been studied about its risk factors, pathophysiology, prevention, and treatment. Despite this, many people still suffer from this condition. Even for those who reach medical care, the path to maintaining significant improvement is neither short nor easy. Here, we propose the ubiquitous individualization of headache treatment. The more we study the condition, the more it becomes evident that different groups of patients benefit from different approaches: starting prophylactic medication immediately or postponing it, providing a bridge treatment or not, and advising patients to either stop medication overuse immediately or reduce it gradually.

Abstract licence: CC BY-SA