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| Interactions: | Clarithromycin
Adverse Effect: acute ergotism (nausea, vomiting, vasospastic ischemia) Clinical Management: Concomitant use is not recommended. However, patients receiving dihydroergotamine and clarithromycin should be monitored for increased ergot toxicity nausea, vomiting, vasospastic ischemia).
Dopamine
Adverse Effect: Peripheral vasoconstriction and gangrene Clinical Management: Concurrent use of ergotamine and dopamine is contraindicated. If coadministration is necessary, monitor patient for peripheral vasoconstriction (painful extremities, cold or pale skin).
Efavirenz
Adverse Effect: Efavirenz causes inhibition of isoenzyme CYP3A4 Ergot alkaloids are mainly metabolized via CYP3A4 so it leads to lower clearance of Ergotamine resulting in serious adverse events. Clinical Management: Avoid concomitant use of Ergot alkaloids and Efavirenz.
Erythromycin
Adverse Effect: acute ergotism (nausea, vomiting, vasospastic ischemia) Clinical Management: Alternative antibiotic therapy should be selected if ergot alkaloids are clearly needed.
Oxprenolol
Adverse Effect: Peripheral ischemia Clinical Management: If used together, monitor for peripheral ischemic effects (eg, cold extremities), and choose a selective beta blocker (eg, atenolol) if ischemia occurs.
Propranolol
Adverse Effect: peripheral ischemia Clinical Management: If used together, monitor for peripheral ischemic effects (eg, cold extremities), and choose a selective beta blocker (eg, atenolol) if ischemia occurs.
Sumatriptan
Adverse Effect: prolonged vasospastic reactions Clinical Management: Concurrent use sumatriptan and ergotamine-containing preparations is contraindicated. At least 24 hours should separate the use of these two drugs.
Timolol
Adverse Effect: Peripheral ischemia Clinical Management: If used together, monitor for peripheral ischemic effects (eg, cold extremities), and choose a selective beta blocker (eg, atenolol) if ischemia occurs.
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