Possible Interaction: Caffeine and Ergotamine

“ Caffeine is thought to have a synergistic action with ergotamine but there seems little hard evidence for this general impression (Dunlop, 1969) and it may act by direct vasoconstriction of the cerebral blood vessels (Ritchie, 1965).”

“However, caffeine potentiates the teratogenic effect of other substances, such as tobacco, alcohol, and acts synergistically with ergotamine and propranolol to induce materno-fetal vasoconstrictions leading to malformations induced by ischemia.”

“From the social perspective almotriptan saved euro7.50 vs. ergotamine plus caffeine.”

“Almotriptan was associated with a significantly lower rate of photophobia at 90 min (P < 0.05), phonophobia at 60, 90, and 120 min (P < 0.05 to <0.01), and nausea and vomiting at 90 and 120 min (P < 0.01) compared with ergotamine plus caffeine.”

“Sixteen patients reported adverse events during almotriptan treatment and 27 patients reported AEs during the ergotamine plus caffeine therapy.”

“These results indicate faster and more complete intestinal absorption of ergotamine administered in combination with caffeine.”

“ Caffeine may cause increased plasma ergotamine concentrations through an as yet inadequately defined pharmacokinetic interaction.”

“Blood flow determinations in a further patient with transient global amnesia, after 2 mg of ergotamine tartrate plus caffeine , showed a global decline in flow without focal anomaly, with recovery after ten days.”

“Friedman5 suggests that the caffeine acts by causing further cerebral vasoconstriction, bringing about psychic stimulation, and perhaps by increasing the rapidity of the absorption of the ergotamine.”

“Possibly the added caffeine works synergistically with the ergotamine.”

“ Caffeine is thought to exert its rate-accelerating effect by increasing the water solubility of ergotamine neutral molecules.”

“The results of a series of experiments showed that caffeine significantly enhanced absorption of ergotamine from solutions of pH 5.0 when both substances were in solution and when an intact blood supply was either absent (in vitro everted sac experiments) or present (in situ experiments).”

“These findings suggest that combination ergotamine and caffeine elicits a seated pressor response that is similar in magnitude to midodrine, and improves symptoms in autonomic failure.”