A friend who fights migraines: Let's learn about Ergotamine Sublingual Tablets.

When you have an unbearable migraine headache, it can be a real pain all day long, right? Sometimes your head hurts so much that you can't even look at the light, you feel nauseous, and some people even vomit. There are times when you can't do anything and just stay in bed all day. Today, we are going to talk about a special medicine that can give you relief when you have such a severe migraine pain.

What kind of medicine is this?

This medicine is called ergotamine . It usually comes as a sublingual tablet that you place under your tongue and dissolve. It is specifically designed to help you control the severe headaches that come with migraines.

Simply put, this medicine, Ergotamine, does two things in your brain. One is to block the pain signals that cause migraines. The other is to cause some of the blood vessels in the brain to swell, which causes those blood vessels to constrict. It belongs to a class of drugs called ergot alkaloids .

However, it is very important to remember this: This medicine is not a medicine to prevent migraines before they occur. This means that you should take it after you start having a headache, that is, after you have symptoms of a migraine. It is not a good idea to take it in anticipation of it happening.

Sometimes your doctor may prescribe this medicine for another purpose. So if you have any questions or are unsure about this medicine, it is best to ask your doctor or pharmacist. You will usually find this medicine under the brand name 'Ergomar' .

What are the things you need to tell your doctor before taking this medicine?

Okay, now this is a very important point. Before you start using this Ergotamine medicine, if you have any of the conditions listed below, you should definitely tell your doctor without hiding anything. Because only then can the doctor decide whether this medicine is suitable for you or not, or how to give it.

Now see if these things apply to you too:

• Do you have chest pain or difficulty breathing?
• Do you have any heart disease or blood vessel disease?
• Do you have high blood pressure?
• Do you have any kind of infection, like a boil, in your body?
• Do you have kidney disease?
• Is there any problem with the liver, i.e. liver disease?
• Do you have poor circulation? This means things like poor blood flow to your extremities, numbness, etc.
• Are you a smoker? Smoking is a risk factor for heart disease.
• Have you ever had an allergic reaction or any other unusual reaction to this ergotamine medication, any other medication, food, dyes, or preservatives?
• Are you currently pregnant? Or are you trying to get pregnant?
• Are you a breastfeeding mother?

If any of these apply to you, please tell your doctor.

How should I use this medicine?

The way this medicine is used is also very special. It is very important to know and do it correctly.

• How to take: This medicine should be taken orally. Take the tablet, place it under your tongue , and wait until it dissolves completely.
• Most importantly: Do not chew or swallow the tablet. Let it dissolve under your tongue. This will ensure that the medicine is fully absorbed into your body.
• Follow the instructions: Follow the instructions on the prescription label given to you by your doctor exactly.
• Best time: For best results, take this medicine as soon as you feel the onset of a migraine headache, or as soon as you start to feel the symptoms that precede a migraine (such as an aura). Don't delay. That's when it will provide the best relief.
• Do not take this medicine regularly: This medicine is not meant to be taken every day. Also, do not take more than the dose your doctor tells you to take, nor do you take it more than the number of times per day that your doctor tells you to take it.
• If giving to children: Be sure to talk to your healthcare team about giving this medicine to young children. It may require special care. Do not give this medicine to young children without the advice of a doctor.
• Overdose: If you think you have taken too much of this medicine, call the nearest poison control center or emergency room immediately. Or go there immediately.
• Do not share: This medicine is for you only. Do not give it to a friend or family member, even if they have a fever. Not all medicines work for everyone.

What to do if you miss a dose?

This question is not very relevant to this medicine. Because, as mentioned before, this is not a medicine that is taken at the same time every day, in a regular manner. It is taken only when a headache comes on Sunday.

What other things can interact with this medicine? (Interactions)

This is also something to be very careful about. There are some medications that can cause dangerous side effects when taken with Ergotamine. Also, there are some other medications and foods that can affect the way Ergotamine works.

Ergotamine should never be taken with the following medications:

• Bromocriptine
• Ceritinib
• Some antibiotics, such as clarithromycin and erythromycin
• Some antivirals given for HIV or hepatitis
• Some medications for high blood pressure, heart disease, and irregular heartbeat
• Some medications for fungal infections, such as itraconazole, ketoconazole, posaconazole, and voriconazole
• Some other medications that are prescribed for migraine headaches include: almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan. These are also called 'triptans'.
• Cocaine
• Idelalisib
• Imatinib
• Levoketoconazole
• Lonafarnib
• Mifepristone
• Pseudoephedrine (may be found in some cold medicines)
• Ribociclib
• Tucatinib

Also, this medicine can interact with the following things. This means that effects may occur:

• Some medications for depression, anxiety, or psychotic disorders
• Clotrimazole (an antifungal)
• Fluconazole (an antifungal)
• Grapefruit juice – Be especially careful with this one. Drinking grapefruit juice while taking ergotamine can increase side effects.
• Metronidazole (a medicine used for certain infections)
• Nicotine – This means tobacco-related products, like cigarettes.
• Propranolol (a medicine used to treat heart disease and high blood pressure)
• Zileuton (a medicine for asthma)

This list does not include all possible drug interactions. Therefore, be sure to give your doctor a complete list of all the medications you take (including those for other conditions, vitamins, herbs, non-prescription drugs, and dietary supplements). Also, be sure to tell your doctor if you smoke, drink alcohol, or use illegal drugs. Some things can interact with your medications and cause problems.

What are the things to be careful about when using this medicine?

There are a few other things you should pay attention to when using ergotamine.

• If there is no relief: If this medicine does not provide much relief from your migraine headaches, or if your headaches are coming on in a different way than usual, talk to your healthcare team. You may need to switch to a different medicine or try a different treatment method to treat your headaches.
• Drowsiness/Dizziness: This medication may make you feel drowsy or dizzy. Therefore, do not drive, operate heavy machinery, or do anything else that requires mental alertness until you know how this medication affects you. To reduce the risk of dizziness or fainting spells, do not get up from a sitting position or a standing position suddenly. Do these things slowly. This is especially important if you are elderly. Drinking alcohol can make this drowsiness, dizziness, and flushing worse. Therefore, avoid alcohol completely while taking this medication.
• Blood circulation: This medicine can slightly reduce the blood circulation to your skin, fingers and toes. This can make you more sensitive to the cold. Your hands and feet may feel cold and numb. Older people are more likely to feel this effect. Therefore , dress well and keep warm in cold weather. Avoid staying in the cold for too long.
• Medication Overuse Headache: This is also a very important issue. If you use migraine medication (not just ergotamine, but also other painkillers) for 10 or more days a month, your migraines may get worse instead of getting better. This is called a 'medication overuse headache'. Therefore, it is very useful to keep a headache diary, recording the days you have headaches, what medication you take, and how much. If your migraine attacks are becoming more frequent, or if your headache pattern changes, be sure to contact your healthcare team and let them know.

What are the possible side effects of this medicine?

Like any medicine, ergotamine can cause side effects in some people. However, not everyone gets them. Some side effects are serious and you should seek medical advice immediately if they occur. Some are not serious and go away after a few days.

If you experience any of these serious side effects, you should tell your healthcare team as soon as possible. Or go to the nearest hospital:

• Allergic reactions: Skin rash, itching, hives, swelling of the face, lips, tongue, or throat. If the throat swells, it can also make it difficult to breathe.
• Changes in the limbs: Burning, pain, tingling, or color changes (like turning pale, blue) in the legs or limbs.
• Symptoms of a heart attack: Pain or tightness in the chest, pain spreading to the shoulders, arms, neck, or jaw, nausea, shortness of breath, cold or clammy skin, fainting, or a sudden feeling of lightheadedness.
• Heart rhythm changes: A sudden increase in the rate of heartbeat (fast heartbeat), feeling like it is beating irregularly (irregular heartbeat), dizziness, fainting, chest pain, difficulty breathing.
• Sudden increase in blood pressure.
• Raynaud's phenomenon: The fingers or toes feel cold, numb, and painful. The color of the fingers may change from pale to blue, then red.
• Epilepsy symptoms (Seizures): This means that they come like a seizure.
• Symptoms of a stroke: Sudden numbness or weakness of the face, arm, or leg (usually on one side of the body), trouble speaking, slurred speech, confusion, trouble walking, loss of balance or coordination, dizziness, a severe headache that comes on for no reason, and a sudden change in vision.
• Severe stomach pain: Sudden, severe stomach pain, bloody diarrhea, fever, nausea, and vomiting.
• Vision loss: Sudden loss of vision, or complete loss of vision.

Side effects that usually do not require medical attention, but you should tell your healthcare team if they persist or bother you:

• Dizziness
• General discomfort or fatigue
• Nausea
• Vomiting

This list includes only a few of the possible side effects. Not all side effects are listed here. If you notice anything unusual, seek medical advice. You can report side effects to the FDA (Food and Drug Administration) in the United States at 1-800-FDA-1088. In Sri Lanka, it is best to report them to your doctor or hospital.

How should I store my medicine?

It is also very important to store your medication properly.

• Keep away from children: Keep it in a place where small children cannot reach it, such as on top.
• Temperature: Store at room temperature, which is between 15 and 30 degrees Celsius (59 and 86 degrees Fahrenheit).
• Packaging: Keep in the foil package it came in until ready to use. Do not remove the tablets.
• Safety: Protect from light and moisture. Do not store in damp places such as the bathroom.
• Expiration: Check the expiration date on the medicine package. Do not use any medicine that has passed that date and throw it away.

This information is a summary only. It may not be all-inclusive. If you have any questions or concerns about this medicine, please talk to your doctor, pharmacist, or other health care provider.

The most important things we need to remember (Take-Home Message)

Okay, so let's recap the most important points about Ergotamine that we talked about today.

• Ergotamine is a medication that is given to control the pain of a migraine headache once it has started. It is not used to prevent migraines.
• This tablet should be placed under the tongue and allowed to dissolve completely. Do not chew or swallow.
• Be sure to tell your doctor about any other medical conditions you have (especially heart disease, high blood pressure, circulatory problems), any other medications you are currently taking, and any allergies you have.
• This medicine can interact with many other medications. So talk to your doctor about that too. You should be especially careful with grapefruit juice.
• Taking the medicine may cause drowsiness and dizziness. Therefore, be careful when driving or doing work that requires concentration.
• Overuse of this medication can make your migraine headaches worse. So only use it as directed by your doctor.
• If you experience any symptoms of a serious side effect (such as chest pain, difficulty breathing, allergic reactions, or stroke symptoms) , seek medical advice immediately.
• This medicine is for you only. Do not give it to anyone else.

So, migraine is a condition that many people suffer from. However, with proper diagnosis and treatment, you can control the pain and live a normal life. If you are also suffering from migraines, it is best to see a doctor and get advice.

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