Caffeine / Ergotamine Dosage

Usual Adult Dose for Cluster Headache

Oral, Sublingual: 2 mg ergotamine in fixed combination with caffeine given as quickly as possible after the first symptom of headache. Additional 1 mg doses can be given every 30 minutes until the headache has been aborted or until a total dose of 6 mg has been reached or 10 mg/week.
rectal: 2 mg ergotamine in fixed combination with caffeine given as quickly as possible after the first symptom of headache. An additional 2 mg dose can be given 1 hour later if the first dose fails to abort the headache. The total dose should not exceed 4 mg/attack or 10 mg/week.

Usual Adult Dose for Migraine

Oral, Sublingual: 2 mg ergotamine in fixed combination with caffeine given as quickly as possible after the first symptom of headache. Additional 1 mg doses can be given every 30 minutes until the headache has been aborted or until a total dose of 6 mg has been reached or 10 mg/week.
rectal: 2 mg ergotamine in fixed combination with caffeine given as quickly as possible after the first symptom of headache. An additional 2 mg dose can be given 1 hour later if the first dose fails to abort the headache. The total dose should not exceed 4 mg/attack or 10 mg/week.

Renal Dose Adjustments

Contraindicated in patients with renal dysfunction

Liver Dose Adjustments

Contraindicated in patients with liver dysfunction

Precautions

The manufacturers of ergotamine preparations consider ergotamine to be contraindicated in the setting of "impaired renal and/or hepatic function".

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

Data not available

Other Comments

If nausea is a significant symptom of headache, an oral dose of metoclopramide may be given at the first sign of headache, then the first dose of caffeine-ergotamine given 20 to 30 minutes later. The sublingual route is generally considered less effective than either the oral or rectal route. Because of their brevity, ergotamine is only occasionally effective in the treatment of cluster headaches.

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