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Ergotamine ball-and-stick.png
Trade namesAlone: Ergomar, others
With caffeine: Cafergot, others
Other names2'-Methyl-5'α-benzyl-12'-hydroxy-3',6',18-trioxoergotaman; 9,10α-Dihydro-12'-hydroxy-2'-methyl-5'α-(phenylmethyl)ergotaman-3',6',18-trione
  • (6aR,9R)-N-((2R,5S,10aS,10bS)-5-Benzyl-10b-hydroxy-2-methyl-3,6-dioxooctahydro-2H-oxazolo[3,2-a]pyrrolo[2,1-c]pyrazin-2-yl)-7-methyl-4,6,6a,7,8,9-hexahydroindolo[4,3-fg]quinoline-9-carboxamide
Clinical data
Main usesMigraines, cluster headaches[1]
Side effectsNausea, abdominal pain, tingling extremities[1]
InteractionsCYP3A4 inhibitors[1]
Routes of
By mouth, under the tongue[1]
External links
US NLMErgotamine
Legal status
BioavailabilityIntravenous: 100%,[3]
Intramuscular: 47%,[4]
Oral: <1%[5] (Enhanced by co-administration of caffeine[3])
Elimination half-life2 hours[4]
Excretion90% biliary[4]
Chemical and physical data
Molar mass581.673 g·mol−1
3D model (JSmol)
  • C[C@@]1(C(=O)N2[C@H](C(=O)N3CCC[C@H]3[C@@]2(O1)O)CC4=CC=CC=C4)NC(=O)[C@H]5CN([C@@H]6CC7=CNC8=CC=CC(=C78)C6=C5)C
  • InChI=1S/C33H35N5O5/c1-32(35-29(39)21-15-23-22-10-6-11-24-28(22)20(17-34-24)16-25(23)36(2)18-21)31(41)38-26(14-19-8-4-3-5-9-19)30(40)37-13-7-12-27(37)33(38,42)43-32/h3-6,8-11,15,17,21,25-27,34,42H,7,12-14,16,18H2,1-2H3,(H,35,39)/t21-,25-,26+,27+,32-,33+/m1/s1 checkY

Ergotamine, sold under the brand names Ergomar among others, is a medication used to treat migraines and cluster headaches.[1] It is not effective for tension headaches.[1] It is taken by mouth, under the tongue, or rectally.[1][6] Onset of effects is generally between 30 minutes and 2 hours.[7]

Common side effects include nausea, abdominal pain, and tingling extremities.[1] Other side effects may include medication overuse headaches, pulmonary fibrosis, and ergotism.[8][1] Use in pregnancy or when breastfeeding may harm the baby.[2] It is not recommended in people with vascular disease, liver, or kidney problems.[8] It is in the ergot family of medications and acts on serotonin among other receptors.[8][7]

Ergotamine was first isolated by Arthur Stoll in 1918 from ergot fungus.[9] The fungus had been used medicinally since at least the 16th century to induce childbirth, treat bleeding after childbirth, or bring about an abortion.[10] In the United States it is generally only used if triptans are not effective; though remains commonly used in some parts of the world.[8] It is also available with caffeine under the brand Cafergot among others.[1]

Medical uses

Ergotamine continues to be prescribed for migraines and cluster headaches.[11]

Availability and dosage

In the United States, ergotamine is available as a suppository, a sublingual tablet, and a tablet, sometimes in combination with caffeine. A suppository is available which contains 2 mg of ergotamine with 100 mg caffeine. A sublingual tablet is available that contains 2 mg of ergotamine. The combination tablet in combination with caffeine called Cafergot contains 1 mg of ergotamine and 100 mg of caffeine.[12]

This preparation may be used immediately following the aura/onset of pain to abort the migraine. For the best results, dosage should start at the first sign of an attack.[13]


Contraindications include: atherosclerosis, Buerger's syndrome, coronary artery disease, hepatic disease, pregnancy, pruritus, Raynaud's syndrome, and renal disease.[14]

It's also contraindicated if people are taking macrolide antibiotics (e.g., erythromycin), certain HIV protease inhibitors (e.g., ritonavir, nelfinavir, indinavir), certain azole antifungals (e.g., ketoconazole, itraconazole, voriconazole) delavirdine, efavirenz, or a 5-HT1 receptor agonist (e.g., sumatriptan). [15]

Side effects

Side effects of ergotamine include nausea and vomiting. At higher doses, it can cause raised arterial blood pressure, vasoconstriction (including coronary vasospasm) and bradycardia or tachycardia. Severe vasoconstriction may cause symptoms of intermittent claudication.[16][11]



Ergotamine interacts with serotonin, adrenergic, and dopamine receptors.[17][18] It is an agonist of serotonin receptors including the 5-HT1 and 5-HT2 subtypes.[17] Ergotamine is an agonist of the serotonin 5-HT2B receptor and has been associated with cardiac valvulopathy.[19] Despite acting as a potent 5-HT2A receptor agonist, ergotamine is said to be non-hallucinogenic similarly to lisuride.[20][21] This is thought to be due to functional selectivity at the 5-HT2A receptor.[20][21]

Activities of ergotamine at various sites[18][22][23][24][25]
Site Affinity (Ki/IC50 [nM]) Efficacy (Emax [%]) Action
5-HT1A 0.17–0.3 ? Full agonist
5-HT1B 0.3–4.7 ? Agonist
5-HT1D 0.3–6.0 ? Agonist
5-HT1E 19–840 ? ?
5-HT1F 170–171 ? ?
5-HT2A 0.64–0.97 ? Full agonist
5-HT2B 1.3–45 ? Partial agonist
5-HT2C 1.9–9.8 ? Partial agonist
5-HT3 >10,000
5-HT4 65 ? ?
5-HT5A 14 ? Agonist
5-HT5B 3.2–16 ? ?
5-HT6 12 ? ?
5-HT7 1,291 ? Agonist
α1A 15–>10,000
α1B 12–>10,000
α1D ? ? ?
α2A 106 ? ?
α2B 88 ? ?
α2C >10,000
β1 >10,000
β2 >10,000
D1 >10,000
D2 4.0–>10,000 Agonist
D3 3.2–>10,000
D4 12–>10,000
D5 170 ? ?
H1 >10,000
H2 >10,000
M1 862 ? ?
M2 911 ? ?
M3 >10,000
M4 >10,000
M5 >10,000
Notes: All receptors are human except 5-HT5A (mouse/rat) and 5-HT5B (mouse/rat—no human counterpart).[18] No affinity for histamine H1 or H2, cannabinoid CB1, GABA, glutamate, or nicotinic acetylcholine receptors, nor the monoamine transporters (all >10,000 nM).[18]


The bioavailability of ergotamine is around 2% orally, 6% rectally, and 100% by intramuscular or intravenous injection.[17] The low oral and rectal bioavailability is due to low gastrointestinal absorption and high first-pass metabolism.[17]

Society and culture


In the United States the 2 mg tablets for under the tongue cost about 63 USD each as of 2021.[26] The version with caffeine on the other hand is about 3 USD per tablet.[27]

Legal status

Ergotamine is a controlled substance in the United States as it is a commonly used precursor for the production of LSD.[28]


Ergotamine is a secondary metabolite (natural product) and the principal alkaloid produced by the ergot fungus, Claviceps purpurea, and related fungi in the family Clavicipitaceae.[29] Its biosynthesis in these fungi requires the amino acid L-tryptophan and dimethylallyl pyrophosphate. These precursor compounds are the substrates for the enzyme, tryptophan dimethylallyltransferase, catalyzing the first step in ergot alkaloid biosynthesis, i.e., the prenylation of L-tryptophan. Further reactions, involving methyltransferase and oxygenase enzymes, yield the ergoline, lysergic acid. Lysergic acid (LA) is the substrate of lysergyl peptide synthetase, a nonribosomal peptide synthetase, which covalently links LA to the amino acids, L-alanine, L-proline, and L-phenylalanine. Enzyme-catalyzed or spontaneous cyclizations, oxygenations/oxidations, and isomerizations at selected residues precede, and give rise to, formation of ergotamine.[30]


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External links