HelixTalk Episode #64 - Should I stay or should ergot?

Date posted: July 25, 2017, 6:00 am

In this episode, we discuss the history of ergot products for treatment of migraines. We compare their safety and efficacy to newer agents such as the triptans and assess their resultant place in therapy.

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Key Concepts

1. The history of ergot and its clinical use is fascinating, and serves as an important milestone in our understanding of pharmacology.
2. Ergot alkaloids are distinct from triptans both in terms of receptor profile (“dirty” given potency for receptors besides 5HT1B/1D) and their pharmacokinetics.
3. There may still be a niche for ergots, so long as you monitor use (less than twice weekly) and advise of the side effect profile and educate on monitoring for rebound migraines.
4. Choose your dosage form carefully -- oral does not always mean better, and rectal is preferred. But the upcoming inhaled versions is certainly intriguing. 

References

Schiff Jr PL. Ergot and Its Alkaloids. American Journal of Pharmacy Education. 2006; 70(5): 1-10.