Cafergot (Ergotamine, caffeine)
How does it work?
Cafergot tablets contain two active ingredients, ergotamine and caffeine. Ergotamine is a type of medicine called an ergot alkaloid. It is used in the treatment of migraines.
Although the cause of migraine attacks is not fully understood, it is thought that widening of blood vessels in the brain causes the throbbing pain of migraine headaches. Ergotamine relieves this pain by causing the blood vessels in the brain to narrow.
Ergotamine works by stimulating receptors called serotonin (or 5HT) receptors that are found in the brain. A natural substance called serotonin normally acts on these receptors, causing blood vessels in the brain to narrow. Ergotamine mimics this action of serotonin by directly stimulating the serotonin receptors in the brain. This narrows the blood vessels and so relieves the pain of migraine headaches.
Ergotamine also acts on other types of receptors found on the walls of blood vessels, called alpha receptors. This also causes the blood vessels to narrow.
Caffeine is also included in this medicine to help enhance the effect of ergotamine.
What is it used for?
- Relieving migraine attacks.
How do I take this?
- Cafergot tablets can be taken either with or without food.
- One or two Cafergot tablets should be taken at the first warning sign of a migraine headache. This should be sufficient to relieve the symptoms of the headache. Your doctor may recommend taking two more tablets if the headache persists. You must not take more than four tablets in 24 hours.
- It is important not to take a repeat dose within four days. This means that if you take four tablets one day you will have to wait four days before taking another dose of the tablets. Do not take more than eight tablets in a week.
- This medicine should only be used by people with a clear diagnosis of migraine from their doctor.
- It is important that you dont exceed the maximum recommended daily and weekly dose of these tablets and that you dont take them on a regular basis to try to prevent migraines. Using too much of the medicine can result in dependence on the medicine and can actually cause headaches.
- If you experience signs of numbness and tingling in the fingers or toes, nausea and vomiting that are not related to your migraine, difficulty breathing, chest pain, dizziness, confusion, or a slow or fast heart rate it is important that you dont take any more tablets and seek medical advice immediately. These may be signs of too much ergotamine in your blood.
Use with caution in
Not to be used in
- A type of migraine where there is a disturbance in brain function which initially presents with total blindness followed by dizziness, speech disturbances, ringing in the ears and double vision (basilar migraine).
- A form of migraine associated with temporary paralysis of one side of the body (hemiplegic migraine).
- An inflammatory condition of the temporal artery, which can lead to stroke or blindness. Symptoms include headaches and tenderness over the temples (temporal arteritis).
- Uncontrolled high blood pressure.
- Coronary heart disease.
- Narrowing of blood vessels in the extremities (peripheral vascular disease).
- Narrowing of the blood vessels in the hands, causing numb and painful fingers (Raynaud's disease).
- Decreased kidney function.
- Decreased liver function.
- Over active thyroid gland (hyperthyroidism).
- Infection of the blood (septicaemia or blood poisoning).
- Hereditary blood disorders called porphyrias.
- People taking HIV medicines such as amprenavir, indinavir, nelfinavir, ritonavir, saquinavir, atazinavir, efavirenz.
- People taking macrolide antibiotics such as erythromycin, azithromycin, clarithromycin.
- People taking azole antifungal medicines such as ketaconazole, miconazole, itraconazole, posaconazole, voriconazole.
- People who have taken a triptan medicine to treat their migraine (see end of page for more information).
- Children under 12 years of age.
This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine should not be used during pregnancy as it may be harmful to the unborn baby. Seek medical advice from your doctor.
- Significant amounts of this medicine may pass into breast milk. It should not be used by breastfeeding mothers as it may be harmful to the nursing infant. Seek medical advice from your doctor.
- Do not take more than four tablets in 24 hours or eight tablets in any one week.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
Common (affect between 1 in 10 and 1 in 100 people)
- Abdominal pain
- Nausea and vomiting not due to migraine.
Uncommon (affect between 1 in 100 and 1 in 1000 people)
- Pins and needles or tingling sensations (paraesthesia).
- Numbness of hands and feet.
- Poor circulation in hands and feet which may make them look pale and blue.
- Narrowing of the blood vessels in the extremities of the body (peripheral vasoconstriction).
- Pain and weakness in the extremities
Rare (affect between 1 in 1000 and 1 in 10,000 people)
- Difficulty breathing.
- Spinning sensation (vertigo).
- Increased blood pressure.
- Decreased heart rate (bradycardia).
- Faster than normal heart beat (tachycardia).
- Pain in the muscles (myalgia).
Very rare (affect less than 1 in 10,000 people)
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, always check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.
You should not take Cafergot in combination with other medicines and drugs that narrow the blood vessels or increase blood pressure (vasoconstrictors and vasopressors, eg ephedrine, phenylephrine, pseudoephedrine, nicotine, triptans, other ergot alkaloids - also see below), as this may increase the risk of serious side effects.
If you are taking any of the following medicines you should not take Cafergot to treat your migraine, because these medicines can reduce the breakdown of ergotamine and increase the risk of its side effects:
- azole antifungals (eg ketoconazole, miconazole,itraconazole, posiconazole, voriconazole)
- macrolide antibiotics (eg telithromycin, erythromycin, clarithromycin,azithromycin )
- protease or reverse transcriptase inhibitors for treating HIV infection (eg ritonavir, indinavir, nelfinavir, amprenavir, fosamprenavir, saquinavir)
You should not take this medicine if you have taken any of the following triptan medicines in the previous six hours: almotriptan, rizatriptan, sumatriptan or zolmitriptan. You should not take this medicine if you have taken eletriptan, frovatriptan or naratriptan in the previous 24 hours. You should not take any triptan medicines until at least 24 hours after taking the last dose of this medicine.
There may be an increased risk of narrowing of the blood vessels in the arms and legs if ergotamine is used in combination with beta-blockers. If you take this medicine in combination with a beta-blocker such as propranolol it is important to let your doctor know if you get cold, numb or painful hands or feet.
If you are taking reboxetine there may be a risk that your blood pressure will rise if you take Cafergot to treat a migraine.
Other medicines containing the same active ingredients
There are currently no other medicines available in the UK that contain ergotamine and caffeine as the only active ingredients.
Migril contains ergotamine and caffeine together with the antisickness medicine cyclizine.