Ergotamine; Caffeine Rectal Suppositories

What is this medication?

ERGOTAMINE; CAFFEINE (er GOT a meen; KAF een) treats migraines. It works by blocking pain signals and narrowing blood vessels in the brain. It is a combination of an ergot alkaloid and caffeine. It is not used to prevent migraines.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Cafergot, Migergot

What should I tell my care team before I take this medication?

They need to know if you have any of these conditions:

• Heart or blood vessel disease
• High blood pressure
• Infection
• Kidney disease
• Liver disease
• Poor circulation
• An unusual or allergic reaction to ergotamine, caffeine, other medications, foods, dyes, or preservatives
• Pregnant or trying to get pregnant
• Breast-feeding

How should I use this medication?

This medication is for rectal use only. Do not take it by mouth. Wash your hands before and after use. Take off the foil wrapping. Wet the tip of the suppository with cold tap water to make it easier to use. Lie on your side with your lower leg straightened out and your upper leg bent forward toward your stomach. Lift upper buttock to expose the rectal area. Apply gentle pressure to insert the suppository completely into the rectum, pointed end first. Hold buttocks together for a few seconds. Remain lying down for about 15 minutes to avoid having the suppository come out. Do not use more often than directed.

Talk to your care team about the use of this medication in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

This does not apply. You should only take this medication at the first sign of an attack. Do not take double or extra doses.

What may interact with this medication?

Do not take this medication with any of the following:

• Adagrasib
• Certain antibiotics, such as erythromycin, clarithromycin, troleandomycin
• Certain antivirals for HIV or hepatitis
• Certain medications for fungal infections, such as fluconazole, ketoconazole, itraconazole, posaconazole
• Certain medications for migraine headache, such as almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan
• Cocaine
• Conivaptan
• Dexfenfluramine
• Ergot alkaloids, such as dihydroergotamine, ergonovine, ergotamine, methylergonovine
• Ephedrine
• Feverfew
• Grapefruit juice
• Imatinib
• Isoproterenol
• Isosorbide
• Midodrine
• Nefazodone
• Nitroglycerin
• Phenylephrine
• Pseudoephedrine

This medication may also interact with the following:

• Certain medications for blood pressure, heart disease, irregular heartbeat
• Clotrimazole
• Fluoxetine
• Fluvoxamine
• Metronidazole
• Nicotine
• Zileuton

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medication?

Check with your care team if you do not get relief from your headaches after using this medication. You may need to be changed to a different kind of medication to treat your migraines.

This medication decreases the circulation of blood to your skin, fingers, and toes. You may get more sensitive to the cold. Elderly patients are more likely to feel this effect. Dress warmly and avoid long exposure to the cold.

This medication contains caffeine. Limit your intake of caffeinated beverages on the days that you use this medication.

If you take migraine medications for 10 or more days a month, your migraines may get worse. Keep a diary of headache days and medication use. Contact your care team if your migraine attacks occur more frequently.

What side effects may I notice from receiving this medication?

Side effects that you should report to your care team as soon as possible:

• Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
• Burning, pain, tingling, or color changes in the hands, arms, legs, or feet
• Dry cough, shortness of breath or trouble breathing
• Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
• Increase in blood pressure
• Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
• Sudden or severe stomach pain, bloody diarrhea, fever, nausea, vomiting
• Shortness of breath, dry cough
• Pain in the lower back or sides

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

• Anxiety, nervousness
• Dizziness
• Nausea
• Rectal pain, burning, or bleeding
• Tremors or shaking
• Vomiting

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medication?

Keep out of the reach of children and pets.

Store in a refrigerator. Do not freeze. Keep medication in sealed foil until just prior to use. Protect from moisture. Get rid of any unused medication after the expiration date.

To get rid of medications that are no longer wanted or have expired:

• Take the medication to a medication take-back program. Check with your pharmacy or law enforcement to find a location.
• If you cannot return the medication, ask your pharmacist or care team how to get rid of this medication safely.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.