Ergotamine

What ergotamine tartrate is and how it works

Ergotamine is a prescription medicine used to stop (abort) an acute migraine or cluster headache attack. It works by narrowing blood vessels that are involved in causing migraine pain, but this same vessel-narrowing action is also the source of its most serious risks. (1)

Ergotamine carries a real, serious risk of excessive blood vessel narrowing (vasospasm), which can cause reduced blood flow to the fingers, toes, or other body parts (ergotism) -- rarely serious enough to cause tissue damage. This risk becomes dangerously higher if ergotamine is combined with certain other medicines, especially some antibiotics, antifungals, and HIV protease inhibitors, so it is critical to tell every prescriber and pharmacist that you take ergotamine. It must not be used by anyone with heart or blood vessel disease, uncontrolled high blood pressure, or during pregnancy. Never take more than the labelled dose, and never use it every day.

Mechanism of action: how ergotamine tartrate works

Ergotamine is a non-selective agonist/partial agonist at serotonergic (5-HT1, 5-HT2), adrenergic, and dopaminergic receptors, producing vasoconstriction of cranial blood vessels that is thought to underlie its antimigraine effect; the same vasoconstrictive action across peripheral vessels underlies its ergotism/ischemia risk. Caffeine is combined to enhance ergotamine absorption. (1)

What ergotamine tartrate is used for

Before taking ergotamine tartrate

Do not take / not appropriate for

• Do not take together with potent CYP3A4-inhibitor medicines -- this combination is absolutely contraindicated and can cause acute ergotism (severe vasospasm and tissue ischemia, in some reported cases leading to amputation). This includes HIV protease inhibitors (such as ritonavir, nelfinavir, indinavir), certain macrolide antibiotics (such as erythromycin, clarithromycin, troleandomycin), and azole antifungals (such as ketoconazole, itraconazole). (all countries where currently available) (1)
• Do not take if you have peripheral vascular disease, coronary heart disease, or uncontrolled high blood pressure. (all countries where currently available) (1)
• Do not take if you have sepsis (a severe infection affecting the whole body). (all countries where currently available) (1)
• Do not take if you have significant liver or kidney impairment. (all countries where currently available) (1)
• Do not take if you are pregnant or could become pregnant -- this medicine can harm the pregnancy and stimulate the uterus. (all countries where currently available) (1)
• Do not take if you have a known hypersensitivity to ergotamine, caffeine, or the product's other ingredients. (all countries where currently available) (1)
• Do not use every day on a chronic basis. (all countries where currently available) (1)

Tell your clinician about

• Every other medicine you take, including antibiotics, antifungals, and any HIV medicines -- this is critical because of the real risk of a dangerous interaction.
• Any history of heart disease, blood vessel disease, high blood pressure, liver disease, or kidney disease.
• Whether you are pregnant, planning pregnancy, or breastfeeding.
• How often you use this medicine -- frequent or daily use raises the risk of serious complications and is not recommended.

How to take ergotamine tartrate

• Take at the very first sign of a migraine attack -- early administration gives the best effect.
• Never exceed the maximum dose per attack or per week set by your prescriber.
• Tell every doctor, pharmacist, and dentist you see that you take ergotamine, so they can check for the serious drug-interaction risk before prescribing anything new.
• Do not use for chronic, daily headache prevention.

Procedures and treatment changes

Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (5) (6)

Missed dose

This medicine is taken only when a migraine or cluster headache attack starts, not on a fixed daily schedule, so a missed dose in the usual sense does not apply. Never take extra doses to make up for a previous attack.

Overdose

Seek emergency medical help immediately if you think you or someone else has taken too much ergotamine, or if you develop numbness, tingling, coldness, or pallor in the fingers or toes, muscle pain when walking, chest pain, or severe nausea and vomiting -- these can be signs of dangerous vessel narrowing (ergotism) that needs urgent treatment. (1)

Side effects

Side effects and their urgency vary; report severe, persistent, or concerning symptoms.

Serious warnings

Interactions

• Potent CYP3A4 inhibitors -- including HIV protease inhibitors (ritonavir, nelfinavir, indinavir), certain macrolide antibiotics (erythromycin, clarithromycin, troleandomycin), and azole antifungals (ketoconazole, itraconazole) -- are absolutely contraindicated with ergotamine because of the real risk of acute ergotism and severe vasospasm. (1)
• Less potent CYP3A4 inhibitors (for example saquinavir, nefazodone, fluconazole, fluoxetine, fluvoxamine, zileuton, metronidazole, clotrimazole, and grapefruit juice) still require caution and discussion with your prescriber, even though they are not an absolute contraindication. (1)
• Combining with other vasoconstrictive migraine medicines (such as triptans) within the same time window is not recommended because of additive vessel-narrowing effects -- follow your prescriber's specific spacing instructions between these medicines. (1)

Pregnancy, breastfeeding, kidney/liver function, age

Monitoring

Before starting

• Full review of current medicines for CYP3A4-inhibitor interactions
• Cardiovascular history and risk factors
• Liver and kidney function
• Pregnancy status where relevant

During treatment

• Watch for any numbness, coldness, or colour change in the fingers or toes.
• Reassess regularly if ergotamine is being used frequently -- it is not intended for chronic daily use.
• Any new medicine (especially antibiotics, antifungals, or antiretrovirals) should be checked against this medicine before starting.

Storage

Store at room temperature, protected from light and moisture, out of reach of children.

Frequently asked questions

References

1. ERGOTAMINE TARTRATE AND CAFFEINE tablet, film coated -- full prescribing informationU.S. Food and Drug Administration / DailyMed (NIH), full prescribing information · United States · accessed 2026-07-31 · source 1
2. Ergotamine Tartrate (Cafergot & Migril) -- 'Do Not Prescribe' traffic-light classificationUK NHS regional medicines management formularies, reporting MHRA/BNF classification · United Kingdom · accessed 2026-07-31 · source 2
3. Ergot derivatives -- referral (scope clarification)European Medicines Agency (EMA) -- Article 31 referral on ergot derivatives · European Union · accessed 2026-07-31 · source 3
4. CAFERGOT TAB (ergotamine tartrate + caffeine tablet) -- Health Canada DPD entry, DIN 00176095Health Canada Drug Product Database (DPD) · Canada · accessed 2026-07-31 · source 4
5. CAFERGOT tablet bottle -- ARTG entry cancelled under s30(1)(c)Therapeutic Goods Administration (TGA), Australia · Australia · accessed 2026-07-31 · source 5
6. Consent to distribute Cafergot tablets prohibited under Section 36 of the Medicines Act 1981, effective 2020-05-01Medsafe (New Zealand regulator) -- Section 36 Medicines Act 1981 prohibition notice · New Zealand · accessed 2026-07-31 · source 6

Brand names by country

Single-ingredient ergotamine tartrate names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.

Priority countries