Drug interactions between caffeine / ergotamine and fluconazole
Interactions between your drugs
Applies to: fluconazole and caffeine / ergotamine
Consumer information for this interaction is not currently available.
GENERALLY AVOID: Coadministration with inhibitors of CYP450 3A4 including azole antifungal agents may increase the plasma concentrations of ergot derivatives, which are primarily metabolized by the isoenzyme. The interaction has occurred in patients receiving ergotamine or dihydroergotamine with potent CYP450 3A4 inhibitors such as macrolide antibiotics and protease inhibitors. Clinical ergotism has been reported, which can lead to gangrene and myocardial infarction in severe cases. Even small, single doses of ergotamine have resulted in clinically significant interactions, occasionally resulting in surgical amputation or death. Within the azole class, itraconazole, ketoconazole, posaconazole and voriconazole are considered potent CYP450 3A4 inhibitors, while fluconazole is comparatively weak and generally causes clinically significant interactions with CYP450 3A4 substrates only at dosages of 200 mg/day or more. It is not known to what extent interactions may occur with clotrimazole troches or miconazole buccal preparations. Although systemic absorption following mucous membrane exposure is limited, the potential for interaction with drugs metabolized by CYP450 3A4 such as ergot alkaloids cannot be ruled out.
MANAGEMENT: Concomitant use of ergot derivatives with fluconazole at high, multiple doses or clotrimazole and miconazole mucous membrane preparations should generally be avoided, if possible. Otherwise, close monitoring for adverse effects such as peripheral vasospasm, ischemia, thrombosis, tachycardia, and hypertension is recommended. Patients should be advised to seek medical attention if they experience potential signs and symptoms of ergotism such as paresthesia, tingling of fingers, cold or painful extremities, numbness, muscle cramps, abdominal pain, rapid pulse, or chest pain.
- Caballero-Granado FJ, Viciana P, Cordero E, Gomez-Vera MJ, del Nozal M, Lopez-Cortes LF "Ergotism related to concurrent administration of ergotamine tartrate and ritonavir in an AIDS patient." Antimicrob Agents Chemother 41 (1997): 1207
- Montero A, Giovannoni AG, Tvrde PL "Leg ischemia in a patient receiving ritonavir and ergotamine." Ann Intern Med 130 (1999): 329
- Vila A, Mykietiuk A, Bonvehi P, Temporiti E, Uruena A, Herrera F "Clinical ergotism induced by ritonavir." Scand J Infect Dis 33 (2001): 788-9
- "Product Information. D.H.E. 45 (dihydroergotamine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
- Rosenthal E, Sala F, Chichmanian RM, Batt M, Cassuto JP "Ergotism related to concurrent administration of ergotamine tartrate and indinavir." JAMA 281 (1999): 987
- Dresser GK, Spence JD, Bailey DG "Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition." Clin Pharmacokinet 38 (2000): 41-57
- Spiegel M, Schmidauer C, Kampfl A, Sarcletti M, Poewe W "Cerebral ergotism under treatment with ergotamine and ritonavir." Neurology 57 (2001): 743-4
- Srisuma S, Lavonas EJ, Wananukul W "Ergotism and factitious hypotension associated with interaction of ergotamine with CYP3A4 inhibitors." Clin Toxicol (Phila) (2014): 1-4
- Horowitz RS, Dart RC, Gomez HF "Clinical ergotism with lingual ischemia induced by clarithromycin-ergotamine interaction." Arch Intern Med 156 (1996): 456-8
- 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
- Francis H, Tyndall A, Webb J "Severe vascular spasm due to erythromycin-ergotamine interaction." Clin Rheumatol 3 (1984): 243-6
- Eadie MJ "Clinically significant drug interactions with agents specific for migraine attacks." Cns Drugs 15 (2001): 105-18
- Hayton AC "Precipitation of acute ergotism by triacetyloleandomycin." N Z Med J 69 (1969): 42
- "Product Information. Migranal (dihydroergotamine nasal)." Novartis Pharmaceuticals, East Hanover, NJ.
- Matthews NT, Havill JH "Ergotism with therapeutic doses of ergotamine tartrate." N Z Med J 89 (1979): 476-7
- Leroy F, Asseman P, Pruvost P, Adnet P, Lacroix D, Thery C "Dihydroergotamine-erythromycin-induced ergotism." Ann Intern Med 109 (1988): 249
- Ausband SC, Goodman PE "An unusual case of clarithromycin associated ergotism." J Emerg Med 4 (2001): 411-3
- Liaudet L, Buclin T, Jaccard C, Eckert P "Severe ergotism associated with interaction between ritonavir and ergotamine." Br Med J 318 (1999): 771
- "Product Information. ORAVIG (miconazole)." Strativa Pharmaceuticals, a Division of Par Pharmaceuticals, Inc., Woodcliff Lake, NJ.
Drug and food interactions
Applies to: caffeine / ergotamine
Grapefruit juice may increase the blood levels and effects of certain medications such as ergotamine. You may want to limit your consumption of grapefruit and grapefruit juice during treatment with ergotamine. However, if you have been regularly consuming grapefruit or grapefruit juice with ergotamine, do not alter the amounts of these products in your diet without first talking to your doctor or other healthcare professional. Contact your doctor if your condition changes or you experience increased side effects. Orange juice is not expected to interact.
Applies to: caffeine / ergotamine
Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed.
For clinical details see professional interaction data.
Therapeutic duplication warnings
No therapeutic duplications were found for your selected drugs.
Drug Interaction Classification
|Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.|
|Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.|
|Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.|
|No information available.|
Do not stop taking any medications without consulting your healthcare provider.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.