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Dihydroergotamine nasal and PCE Dispertab

Determining the interaction of Dihydroergotamine nasal and PCE Dispertab and the possibility of their joint administration.

Check result:

Dihydroergotamine nasal <> PCE Dispertab

Relevance: 23.05.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Using dihydroergotamine together with erythromycin is not recommended. Combining these medications may significantly increase the blood levels and effects of dihydroergotamine, which in some cases can lead to excessive narrowing of blood vessels in the body. This can reduce blood flow to vital organs and increase the risk of rare but serious side effects such as high blood pressure, heart attack, stroke, and gangrene (death of tissues, usually in the arm or leg, that may require surgical amputation). You should seek immediate medical attention if you experience severe abdominal pain, nausea, vomiting, numbness or tingling, muscle pain or weakness, blue or purple discoloration of fingers or toes, pale or cold skin, chest pain or tightness, irregular heartbeat, severe headache, shortness of breath, blurred vision, confusion, and/or slurred speech during treatment with dihydroergotamine. Do not take larger doses or use the drug more frequently than prescribed. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

CONTRAINDICATED: Coadministration with certain macrolide antibiotics may significantly increase the plasma concentrations of ergot derivatives. The mechanism is macrolide inhibition of CYP450 3A4, the isoenzyme responsible for the metabolic clearance of ergotamine and related drugs. Macrolides that may significantly inhibit CYP450 3A4 include clarithromycin, erythromycin and troleandomycin, and clinical ergotism has been reported in patients receiving ergotamine or dihydroergotamine with these agents. Azithromycin and dirithromycin are generally believed to have little, if any, effect on CYP450 3A4.

MANAGEMENT: Given the potential for ergot toxicity characterized by peripheral vasospasm, ischemia, thrombosis, tachycardia and hypertension, concomitant use of ergot derivatives with clarithromycin, erythromycin, or troleandomycin is considered contraindicated. Although clinical data have not been reported, some manufacturers also consider the combination of cabergoline with macrolides contraindicated or to be avoided on theoretical grounds. Azithromycin may be a safer alternative during therapy with ergot derivatives.

References

"Product Information. Cafergot (caffeine-ergotamine)." Novartis Pharmaceuticals, East Hanover, NJ.
Leroy F, Asseman P, Pruvost P, Adnet P, Lacroix D, Thery C "Dihydroergotamine-erythromycin-induced ergotism." Ann Intern Med 109 (1988): 249
Matthews NT, Havill JH "Ergotism with therapeutic doses of ergotamine tartrate." N Z Med J 89 (1979): 476-7
Ghali R, De Lean J, Douville Y, Noel HP, Labbe R "Erythromycin-associated ergotamine intoxication: arteriographic and electrophysiologic analysis of a rare cause of severe ischemia of the lower extremities and associated ischemic neuropathy." Ann Vasc Surg 7 (1993): 291-6
Srisuma S, Lavonas EJ, Wananukul W "Ergotism and factitious hypotension associated with interaction of ergotamine with CYP3A4 inhibitors." Clin Toxicol (Phila) (2014): 1-4
Francis H, Tyndall A, Webb J "Severe vascular spasm due to erythromycin-ergotamine interaction." Clin Rheumatol 3 (1984): 243-6
Hayton AC "Precipitation of acute ergotism by triacetyloleandomycin." N Z Med J 69 (1969): 42
"Product Information. D.H.E. 45 (dihydroergotamine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
Ausband SC, Goodman PE "An unusual case of clarithromycin associated ergotism." J Emerg Med 4 (2001): 411-3
Eadie MJ "Clinically significant drug interactions with agents specific for migraine attacks." Cns Drugs 15 (2001): 105-18
Bird PA, Sturgess AD "Clinical ergotism with severe bilateral upper limb ischaemia precipitated by an erythromycin - ergotamine drug interaction." Aust N Z J Med 30 (2000): 635-6
Dresser GK, Spence JD, Bailey DG "Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition." Clin Pharmacokinet 38 (2000): 41-57
Nakatsuka A, Nagai M, Yabe H, et al. "Effect of clarithromycin on the pharmacokinetics of cabergoline in healthy controls and in patients with Parkinson's disease." J Pharmacol Sci 100 (2006): 59-64
Horowitz RS, Dart RC, Gomez HF "Clinical ergotism with lingual ischemia induced by clarithromycin-ergotamine interaction." Arch Intern Med 156 (1996): 456-8
"Product Information. Migranal (dihydroergotamine nasal)." Novartis Pharmaceuticals, East Hanover, NJ.
Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

Dihydroergotamine nasal

Generic Name: dihydroergotamine

Brand name: DHE. 45, Migranal

Synonyms: Dihydroergotamine (injection), Dihydroergotamine

What is Dihydroergotamine nasal?

PCE Dispertab

Generic Name: erythromycin

Brand name: EES. Granules, EES-400 Filmtab, EryPed 200, EryPed 400, Ery-Tab, Erythrocin Lactobionate, Erythrocin Stearate Filmtab, PCE Dispertab, E. E. S, EryPed, Erythrocin, Erythromycin Filmtabs, Erythromycin Lactobionate - IV

Synonyms: PCE Dispertab (Oral), PCE, PCE (Oral)

What is PCE Dispertab?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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