Adverse effects
In this section you can find specialist information about the effects and adverse effects of Cafergot® and Imitrex® / Sumatriptan.
Cafergot® tablet : >>> English packet insert
Imitrex® Sumatriptan : >>> English packet insert
If one compares the specialist information about (Imitrex®, Triptan) with that of (Cafergot N®), it becomes quickly apparent, that Triptan does not entail fewer risks than Ergotamine. It is always said of Ergotamine that a high and frequent dosage of the medication can lead to permanent headaches, which are difficult to treat when taken over a long time. But the same problem occurs, if you abuse triptans !
>>> Quotation "The overuse of triptans leads to daily migraine-like headache or to the increase of migraine frequency. The delay between the drug overuse and onset of daily headache is shortest for triptans (1.7 years), longer for ergots (2.7 years)"
Patented medication normally is more expensive. Ergotamine is no longer protected by a patent, and is therefore cheaper. From an economic point of view it is very interesting for manufacturers of patented medications to force cheaper competitive products off the market by claiming they are not effective and have a higher risk of adverse effects. Since financial support for research is usually invested in projects which promise a high economic benefit, it is not surprising that there are no further research activities regarding Ergotamine.
In migraine therapy you should not use >>> any kind of medication more than 8 times per month, and you should not use it on more than three consecutive days. Otherwise there is a possible risk of "Medication Overuse Headaches" (MOHs)
In my opinion Ergotamine isn't an abortive treatment at all, I would like to point out the following regarding this issue:
1. Any medication can lead to adverse effects, including death, when taken in the wrong dosage or when administered incorrectly. The important question is whether or not the correct administration and/or dosage of the medication can also lead to dangerous risks!
2. Triptans can lead to permanent headaches as well as a number of other problems when used too frequently or in an excessive dosage.
If used in a correct manner, Ergotamine is a safe drug. The superiority of Ergotamine administered rectally compared to Sumatriptan was proven in a comprehensive scientific study conducted in 1998 (double-blind study).
Quotation: >>> Curr Headache Report, 2003 feb; 7(1): 55-62, Bigal me, Tepper sj
"The ergot alkaloids were the first specific antimigraine therapy available. However, with the advent of the triptans, their use in the treatment of migraine has declined and their role has become less clear. This review discusses the pharmacology, efficacy, and safety of the ergots. In randomized clinical trials, oral ergotamine was found to be superior to placebo, but inferior to 100 mg of oral sumatriptan. In contrast, rectal ergotamine was found to have higher efficacy (73% headache relief) than rectal sumatriptan (63% headache relief). Intranasal dihydroergotamine was found to be superior to placebo, but less effective than subcutaneous and intranasal sumatriptan. Ergotamine is still widely used in some countries for the treatment of severe migraine attacks. It is generally regarded as a safe and useful drug if prescribed for infrequent use, in the correct dose, and in the absence of contraindications; however, safer and more effective options do exist in the triptans. In patients with status migrainous and patients with frequent headache recurrence, ergotamine is still probably useful."
3. For many decades, patients were prescribed only Ergotamine tablets in a stable combination with additional pain killers and sleeping aids, in particular in Germany. It is known that these pain killer substances can cause permanent headaches, as mentioned before, when they are used incorrectly. There are no scientific studies about the frequency of permanent headaches caused by the intake of pure Ergotamine.
The fact that ergotamine is not very efficient when taken in tablet form has been known for many years.
Most clinical studies of medications test the efficacy of Ergotamine in tablet form against that of Triptan despite this fact, and then produce results about the poor efficacy of the drug.
This procedure makes just as much sense, however, as administering insulin to patients as a tablet instead of by means of an injection. Since Insulin is only effective in the treatment of diabetes when administered by an injection, taking it in tablet form will also be seen as not being effective.
A fair comparison of the efficacy of Triptans and Ergotamine should thus be carried out with Ergotamine as a suppository or the watered-down rectal Ergotamine solution.
A study conducted in 1991 already pointed this out:
Quotation: >>> Clin Pharmacokine. 1991 Jul; 21(1):11-26 , van Hoogdalem E, et al.
"For a number of drugs the extent of rectal absorption has been reported to exceed oral values ... This phenomenon has been reported for ... Ergotamine ... and others."
4. It has been generally scientifically proven that the consumption of less than 20 mg of Ergotamine per month, 10 mg per week or 6 mg per day, administered orally as a tablet or as a suppositoriy, usually does not cause medical problems (neither permanent headaches nor ergotism).
The maximum dosage of 3 mg per month or 1 mg per week of Ergotamine indicated by me only makes up one sixth of the amount classified as safe. My experience with the medication has shown that three milligrams of Ergotamine can effectively treat up to six migraine attacks per month using a dosage of half a milligram per attack, which I classify as an effective dosage when it is administered in the form of a rectiole.
A patient treating three migraine attacks per month using my method would thus use only 1.5 mg of Ergotamine per month, so less than a tenth of the dosage which is classified as safe.
It has been known for decades that Ergotamine administered orally in the form of a tablet is not effective unless taken in a high dosage. For this reason, many desperate patients often used more than the prescribed amount, and in some cases took more than 80 mg of Ergotamine per month in combination with pain killers or sleeping aids. Of course, this kind of abuse of Ergotamine is very dangerous.
5. Rectal infections and ulcers
The first case of a rectal infection after abusing Ergotamine with the name "Gangrenous Ergotism" was registered in 1980 by >>> Grußendorf and Wienert. During my medical training as a specialist physician, these two colleagues were my senior physicians at the RWTH in Aachen,Germany. I am also personally familiar with this case. In this case and in many further cases, the affected patients had taken Ergotamine extremely frequently, over a long period of time and in an excessive as well as uncontrolled dosage. Some used more than 80 mg of Ergotamine per month. The consequences of this type of medication abuse cannot be used as an objective argument against my proposed therapy with a low dosage of Ergotamine.
Research carried out by Jost 1999 showed that there was no incidence of medical anal issues following the proper administration of Ergotamine.
>>> Wolfgang H. Jost Ergotamine-induced rectal lesions: Prospective study on frequency in asymptomatic patients , Coloproktology, 01/09 ; 255-8
Research carried out by Eckhardt / Remmele showed, that rectal ulcers always are a consequence of an excessive dosage.
>>> Eckhardt/Remmele, Anorectal Ergotism: Another Cause of Solitary Rectal Ulcers, Gastroenterology 1986;91: 1123-7
"In each case the weekly number of suppositories applied far exceeded the recommended maximal dose. All patients had taken ergotamine preparations for years, but usually increased the dosage during the week before the occurrence of symptoms.”
Nearly all ulcers could be treated easily and healed completely within a short time period.
