Caffeine; Ergotamine rectal suppositories

What is this medicine?

CAFFEINE; ERGOTAMINE (KAF een; er GOT a meen) is part of a group of medicines called ergot alkaloids. It is used to treat or prevent migraine and cluster headaches.

How should I use this medicine?

This medicine is for rectal use only. Do not take by mouth. Wash your hands before and after use. Take off the foil wrapping. Wet the tip of the suppository with cold tap water to make it easier to use. Lie on your side with your lower leg straightened out and your upper leg bent forward toward your stomach. Lift upper buttock to expose the rectal area. Apply gentle pressure to insert the suppository completely into the rectum, pointed end first. Hold buttocks together for a few seconds. Remain lying down for about 15 minutes to avoid having the suppository come out. Do not use more often than directed.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue

• breathing problems

• chest pain or tightness

• cold hands or feet

• confusion

• fast, slow, or pounding heartbeat

• leg or arm pain or cramps

• rectal discomfort or sores

• seizures

• stomach pain

• swelling of hands, ankles, or feet

• tingling, pain, or numbness in the face, hands, or feet

• vomiting

• weakness

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• headache

• increased urination

• nausea

What may interact with this medicine?

Do not take this medicine with any of the following medications:

• antifungal drugs like fluconazole, itraconazole, ketoconazole posaconazole, or voriconazole

• certain antibiotics like erythromycin, clarithromycin, and troleandomycin

• cocaine

• conivaptan

• dexfenfluramine

• ephedrine

• feverfew

• grapefruit juice

• imatinib

• isoproterenol

• medicines called nitrates like isosorbide and nitroglycerin

• medicines for colds, flu, or breathing difficulties like phenylephrine and pseudoephedrine

• medicines for HIV or AIDS called protease inhibitors, delavirdine, efavirenz, nelfinavir

• medicines for migraine headache like almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan

• midodrine

• nefazodone

• other ergot alkaloids like bromocriptine, cabergoline, dihydroergotamine, ergoloid mesylates, ergonovine, methylergonovine, and methysergide

This medicine may also interact with the following medications:

• clotrimazole

• fluoxetine

• fluvoxamine

• medicines for high blood pressure, especially beta-blockers

• metronidazole

• nicotine

• zileuton

What if I miss a dose?

This does not apply. You should only take this medicine at the first sign of an attack. Do not take double or extra doses.

Where should I keep my medicine?

Keep out of the reach of children.

Store below 25 degrees C (77 degrees F). Keep medication in sealed foil until just prior to use. Protect from moisture. Throw away any unused medicine after the expiration date.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

• heart or blood vessel disease

• high blood pressure

• infection

• kidney disease

• liver disease

• poor circulation

• an unusual or allergic reaction to caffeine, ergotamine, other medicines, foods, dyes, or preservatives

• pregnant or trying to get pregnant

• breast-feeding

What should I watch for while using this medicine?

Check with your doctor or health care professional if you do not get relief from your headaches after using this medicine. You may need to be changed to a different kind of medicine to treat your migraines.

This medicine decreases the circulation of blood to your skin, fingers, and toes. You may get more sensitive to the cold. Elderly patients are more likely to feel this effect. Dress warmly and avoid long exposure to the cold.

This medicine contains caffeine. Limit your intake of caffeinated beverages on the days that you use this medicine.

If you take migraine medicines for 10 or more days a month, your migraines may get worse. Keep a diary of headache days and medicine use. Contact your healthcare professional if your migraine attacks occur more frequently.