Med help: Ergotamine tartrate
Doug & Tracy Cramer
Cafergot for migraines and loved it. I take one pill, wait 30 minutes, if
the migraine isn't gone, I take another, repeat up to 4 pills. The only side
effects I experienced were some nausea and some hot/cold spells.
Since Katie was born, I switched to Imitrex. The problem is that I use the
nasal spray and only get 6 doses per Rx, which runs me $15, costs my
insurance co. $115, and only lasts 3 months or so. My Rx for Cafergot
generally lasted almost a whole year.
I'm out of Imitrex and trying to decide what to do. I've looked up
Ergotamine Tartrate in Hale's and it says that it's contraindicated in
breastfeeding mothers by the AAP, but I'm not totally convinced based on
what Hale has to say. One study done in 1934 suggests that it's passed and
can affect the child, but another study done in 1980 says that short term
use should be no problem.
The info is this:
half life: 21 hours (terminal) -- I have no clue what this means!
peak: .5-3 hours
molecular weight: 581
oral bioavailability: <5%
I also found on the internet that the protein binding for ergotamine
tartrate is 93-98%, which is another thing in its favor.
Based simply on the high molecular weight, the poor oral bioavailability and
high protein binding, plus the fact that I generally only take 2 pills at
the most, I would think this is worth a try.
Does anyone want to take a stab at this and let me know what they think?
FWIW, Katie is almost 19 months old, but still nurses quite often. If
necessary, I'm sure I could put her off nursing for a while (couple hours)
if I take the drug.
Thanks,
Tracy
Kerry and Jack
>
> half life: 21 hours (terminal) -- I have no clue what this means!
> peak: .5-3 hours
> molecular weight: 581
> oral bioavailability: <5%
>
> I also found on the internet that the protein binding for ergotamine
> tartrate is 93-98%, which is another thing in its favor.
>
I think the low oral bioavailability, coupled with the higher protein
binding are the biggest things in your favor. The amount that would actually
make it into her system is SO small, as to be insignificant. Also taking
into consideration the age of your baby, I would have no problems taking
this medication personally. Especially if you knew it would help you when no
other drugs would.
What is the significance of molecular weight?
Kerry
Doug & Tracy Cramer
news:slcG7.1100541$si5.30...@typhoon.kc.rr.com...
> I think the low oral bioavailability, coupled with the higher protein
> binding are the biggest things in your favor. The amount that would
actually
> make it into her system is SO small, as to be insignificant. Also taking
> into consideration the age of your baby, I would have no problems taking
> this medication personally. Especially if you knew it would help you when
no
> other drugs would.
Thanks, Kerry, that's my thinking too. I could continue to take the Imitrex,
but it's a real pain in the ass to have to continually worry about whether
I'm going to run out and not be able to get a new Rx in time, etc.
> What is the significance of molecular weight?
According to Hale, if the molecular weight is over 200, the drug is less
likely to pass into breastmilk. Since this one is way over, I think that's
another thing in its favor and leads me to believe that I should at least
try it and just watch Katie for problems.
Thanks again,
Tracy
Kate J
potential for serious harm. It constricts blood vessels and can cause
strokes. I would ask an expert (i.e. a doctor or pharmacist) rather
than trying to do amateur pharmacodynamic analysis. Chances are though
that even if it's true that the baby may not get much, they will play
safe and not recommend it. Here's an article which agrees with me:
*****************************************************************************
Can Fam Physician 2000 Sep;46:1753-7
Which drugs are contraindicated during breastfeeding? Practice
guidelines.
Moretti ME, Lee A, Ito S. Hospital for Sick Children, Toronto.
QUESTION: Many breastfeeding mothers are concerned about taking
medications that might affect their babies. Are there any guidelines
on which drugs are safe? ANSWER: Only a few drugs pose a clinically
significant risk to breastfed babies. In general, antineoplastics,
drugs of abuse, some anticonvulsants, ergot alkaloids, and
radiopharmaceuticals should not be taken, and levels of amiodarone,
cyclosporine, and lithium should be monitored.
*****************************************************************************
There are plenty of other, safer drugs on the market for migraine
these days. Why not ask your doctor to look into prescribing something
that is known to be safe in breastfeeding?
Cheers,
Kate
"Doug & Tracy Cramer" <tDOcra...@SPAMtoad.MEnet> wrote in message news:<f3cG7.2276$MP.7...@newsfeed.slurp.net>...
Kate J
a bit rude. It's just that I have quite a bit of time recently reading
- esp. on misc.kids - various anti-doctor anti-medicine diatribes and
I get a bit edgy. I used to be a doctor - a long time ago - and have a
very different impression of the profession than the somewhat cynical
one that seems to prevail on these groups (not that Drs aren't without
their faults, and I agree there is woeful ignorance about
breastfeeding. But not generally about drugs).
Anyway my family are almost all migraineurs and I know how awful it
can be so I hope you can find an effective, cheap drug that your
insurance will happily pay for. I'm so glad I don't live in the USA.
For all the faults of the British nedical system, at least over here
we can get (most) drugs we need without factoring cost into it (with a
few notable exceptions).
Good luck!
Kate
Doug & Tracy Cramer
news:6dc3da0.01110...@posting.google.com...
> I should apologise if my last post about "amateur pharcodynamics" was
> a bit rude. It's just that I have quite a bit of time recently reading
> - esp. on misc.kids - various anti-doctor anti-medicine diatribes and
> I get a bit edgy. I used to be a doctor - a long time ago - and have a
> very different impression of the profession than the somewhat cynical
> one that seems to prevail on these groups (not that Drs aren't without
> their faults, and I agree there is woeful ignorance about
> breastfeeding. But not generally about drugs).
Nah, Kate, it's ok. Actually I have a rather interesting update to this.
I saw the doctor today. I was prepared to discuss both the Cafergot and
Imitrex with him and listen to his opinion. However, he seemed to mistake my
unhappiness with the effects of Imitrex (bitter drainage for about 20
minutes) with a desire to go an entirely *different* direction and wrote an
Rx for Maxalt tablets!
Now, here's the rub for me. First of all, between Maxalt and Imitrex,
Imitrex is preferred because of the shorter half-life, higher molecular
weight, higher protein binding and lower oral bioavailability. Maxalt is
similar to Zomig in its characteristics and while I think Zomig is perfectly
fine to take, why should I switch if Imitrex works? Secondly, I currently
take the nasal spray version of the Imitrex and generally have full relief
from the migraine within 30 minutes. I asked about how long the Maxalt
tablet would take to get rid of the migraine -- 1-2 hours!
Ok, so he wanted to prescribe a drug that would take longer to work and be
more likely to pass through breastmilk?? Duh, is all I can say. The topper
is that Maxalt, like the Imitrex, can only be prescribed in 6 doses per Rx,
which is an issue for me as well. He totally seemed to not understand why I
handed the Rx for Maxalt back and asked for an Rx for the Imitrex spray.
So, on to the Cafergot issue. He wouldn't even discuss it with me and wants
me to see a neurologist if I really want to take it again at some point.
My problems with this are:
1) I took Cafergot for 3 years before I got pregnant and am quite aware of
the potential side effects as well as symptoms of ergotamine poisoning. The
side effects I experienced were quite mild (nausea when I first started
taking it, some hot/cold flashes), so I feel that I'm a good candidate for
this drug as I've proven that it doesn't cause problems for me.
2) His main concern was that it can cause hypertension. Hello, my blood
pressure today was 110/80, which is *high* for me -- many times nurses have
problems getting a good reading on me and have asked if I'm even alive. I
estimate that I would take 4-6 pills per month, which really should not be
enough to worry.
3) He seemed to think because I only get about 2 migraines per month, there
isn't cause to have me taking Cafergot. This reasoning doesn't make sense to
me because on one hand he goes on about the potential side effects and
possibility of ergotamine poisoning, but then says I wouldn't take it enough
to make it a good choice for me? Something doesn't make sense here.
The biggest problem I have with the Imitrex is the convenience factor. I
have to get 4 Rxs per year or so for the Imitrex vs. one for the Cafergot,
simply because of insurance limitations. Because there is no generic
equivalent of the Imitrex, I have to pay $15 per Rx for it (so $60 per year
vs. $5). This tends to make me really ration the Imitrex, rather than taking
it immediately when I get a migraine, like I used to do with the Cafergot.
It drives me bonkers because I end up feeling crappy for a lot longer than
I'd have to.
I admit it quite freely that I AM an amateur about medications and don't
believe I know more about the meds than the doctor in most cases, but I do
recognize that I have the most to lose with it so it's a good idea to be as
knowledgeable as possible. If I get a migraine, I'm the one that's in pain,
not the doctor. If I would have taken the Maxalt Rx, I'd be in for waiting
at least twice as long for relief, with no benefits (such as an easier or
cheaper Rx to fill).
As for the Cafergot, I just would like *someone* to explain why exactly this
drug would be completely contraindicated in my particular case for the
reasons I've outlined in my previous posts. If the drug had better oral
bioavailability or a lower molecular weight, fine, I'd put up with the
Imitrex. But it doesn't seem right to dismiss it out of hand when I've had a
very positive experience with it before and would like to see if there's any
possibility of using it again.
I do plan to see the neurologist just to see if I can get an answer without
being brushed off so quickly. I'm also going to stop in and talk to my
friendly neighborhood pharmacist to see if she can shed some light.
BTW, I was amazed to find out that LSD is made from ergotamine tartrate and
that's why it's so highly controlled.
Tracy
(who's getting a headache just dealing with all these migraine med issues!)
Kate J
> me to see a neurologist if I really want to take it again at some point.
Yeah, it sounds like talking to a neurologist would probably clear
things up. They might even be able to find a way around the
prescription problem? It seems kind of crazy to me to prescribe a drug
based on insurance schedules rather than clinical need.
About the Cafergot - it seems like there are two issues, (1) is it
good for you, and (2) is it bad for the baby? Maybe it is the best
drug for you but not wile you are breastfeeding? Good luck with your
discussion! (I think Drs are pretty twitchy about ergotamine because
it is very lethal in accidental overdoes and who knows what it does to
a small baby. And is it something you would want round the house with
a toddler? Those are all issues that would come into it. It is *nasty*
stuff, despite the wonderful effects it has on migraines!).
Cheers,
Kate
Doug & Tracy Cramer
> > So, on to the Cafergot issue. He wouldn't even discuss it with me and
wants
> > me to see a neurologist if I really want to take it again at some point.
>
> Yeah, it sounds like talking to a neurologist would probably clear
> things up. They might even be able to find a way around the
> prescription problem? It seems kind of crazy to me to prescribe a drug
> based on insurance schedules rather than clinical need.
Well, see that's the thing...if I *needed* 6 doses of Imitrex per month,
they'd give me 6 doses per month - with one Rx per month. The insurance
company isn't limiting the number of doses of Imitrex, just the number of
doses per Rx, which is pretty common.
> About the Cafergot - it seems like there are two issues, (1) is it
> good for you, and
I realize that there are people who are not good candidates for it. Having
taken it, though, for 3 years prior to 1999, I think I've proven that I'm a
good candidate. Whether it's "good" for me isn't an issue...it's whether it
works for me and I've done well with it.
>(2) is it bad for the baby? Maybe it is the best
> drug for you but not wile you are breastfeeding?
And this is the rub. The doctor didn't even want to listen to *why* I think
I should be able to try it. I talked to my pharmacist on Friday night and
she confirmed that my reasoning is sound, and that I should see the
neurologist to see what she says.
> Good luck with your
> discussion! (I think Drs are pretty twitchy about ergotamine because
> it is very lethal in accidental overdoes and who knows what it does to
> a small baby. And is it something you would want round the house with
> a toddler? Those are all issues that would come into it. It is *nasty*
> stuff, despite the wonderful effects it has on migraines!).
This to me isn't good reasoning as I keep a lot of things in my house that
aren't necessarily something that I'd want around the house with a toddler,
but I don't plan to get rid of all my cleaning supplies, alcohol, paint,
glue, markers, and other prescription meds. As before, I'd keep it in the
child-proof container in a location the toddler can't reach, as I do with
other things she shouldn't have.
Tracy