Drug interactions between ergotamine and fluconazole
Interactions between your drugs
Applies to: fluconazole and 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.
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- Eadie MJ "Clinically significant drug interactions with agents specific for migraine attacks." Cns Drugs 15 (2001): 105-18
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- "Product Information. ORAVIG (miconazole)." Strativa Pharmaceuticals, a Division of Par Pharmaceuticals, Inc., Woodcliff Lake, NJ.
Drug and food interactions
Applies to: ergotamine
Grapefruit juice may increase the blood levels 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 the medication, then it is advisable for you to talk with your doctor before changing the amounts of these products in your diet, as this may alter the effects of your medication. Contact your doctor if your condition changes or you experience increased side effects. Orange juice is not expected to interact.
Therapeutic duplication warnings
No warnings were found for your selected drugs.
Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.
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.
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