Triptan and ergotamine overdoses in the United States: Analysis of the National Poison Data System.

OBJECTIVE: To examine the clinical outcomes of intentional overdoses involving triptans and ergotamines with a retrospective review of the National Poison Data System (NPDS). METHODS: This was a 5-year retrospective cross-sectional study (2014-2018) using the NPDS. Demographics, exposure characteristics, and outcomes were described. Univariate logistic regression was used to estimate the odds ratio (OR) for major effect or death. A multivariable logistic regression model with inclusion criteria of p < 0.1 in univariate analysis was implemented with backwards selection. RESULTS: In this population (n = 1,489), multiple exposure was most common (n = 1,145). The mean age was 31.2 years and 1,197 (80.4%) participants were female. Major effects from a single exposure were seen in <1% with no recorded deaths. Triptan ingestion (n = 328) resulted in hypertension (14%), tachycardia (10.7%), drowsiness (11%), nausea (6.4%), vomiting (4.6%), vertigo (4%), chest pain (3.7%), and diaphoresis (2.4%). Ergotamine ingestion (n = 16) resulted in abdominal pain (16%), vomiting (12.5%), numbness (12.5%), nausea (6.3%), diarrhea (6.3%), and vertigo (6.3%). No clinical effect was seen in 90 (26.2%). No cases met Hunter criteria for serotonin syndrome. There is risk of major event or death due to age (OR 1.02; 95% confidence interval [CI] 1.01-1.04; p = 0.004), multiple product exposure (OR 9.50; 95% CI 2.29-39.48; p = 0.002), and concomitant overdose with benzodiazepines (OR 1.71; 95% CI 1.05-2.78; p = 0.032) or tricyclic antidepressants (OR 3.16; 95% CI 1.88-5.31; p < 0.001). CONCLUSION: The risk of major effect or death was low and predicted by age, multiple product exposure, and concomitant benzodiazepine or tricyclic antidepressant. The triptan toxidrome consists of hypertension, tachycardia, and drowsiness. The toxic effects of ergotamine are acute gastrointestinal syndrome with vertigo and numbness. No cases of serotonin syndrome were seen.

[Ergotamine poisoning: a case study]. / Zatrucie ergotamina: opis przypadku.

Ergotamine is a well known pharmacological remedy applied in neurology (treatment of vascular headache) and in obstetrics (abortive remedy, uterus atony). But today it is rarely used, because of new safer anti-migraine medicine (triptanes) which cause fewer side effects. According to obstetrical indications ergotamine is applied only in hospital treatment. For that reason, cases of intoxication by this class of drugs are rarely observed. Ergotamine causes constriction of the blood vessels through the blockade of alpha-receptors and stimulation of the serotonin-receptors on the walls of blood vessels both in the central nervous system and in peripheral circulation. Intoxication/overdose symptoms may appear on application of therapeutic dose by sensitive patients, mostly by patients with migraine headache using ergotamine preparation for relief of migraine attacks. In the Regional Centre of Clinical Toxicology, a 21-year-old patient was hospitalized. She took about 20 tablets of Cafergot (complex preparation containing 1mg ergotamine tartare and 100mg caffeine). During her stay on the ward, typical symptoms of severe poisoning were observed: nausea, severe vomiting, dizziness, decreased blood pressure without perceptible pulse, narrowing of the blood vessels in the extremities of the body (peripheral vasoconstriction) - paresthesia, digital cyanosis, refrigeration of legs, angina. Due to taking once of a great dose of the drug by the patient, violent process of intoxication, possibility of dangerous complication and also the unavailability of specific antidotes and lack of efficient methods of extracorporeal elimination of the drug, the patient was intensively controlled and symptomatic treatments according to the law of intensive therapy was applied.

Ergotismo secundario a la asociación ergotamina-ritonavir: A propósito de 3 casos / Ergotism secondary to ergotamine-ritonavir association: Report of three cases

Ergotism is a complication of the acute intoxication or chronic abuse of ergot derivatives. It may be manifested by a vasomotor syndrome with peripheral vascular disease frequently involving extremities. We report three patients infected with human immunodeficiency virus (HIV), in antiretroviral treatment (ART) that included a protease inhibitor as ritonavir, and had received self-medicated ergotamine. They developed symptoms of peripheral vascular disease and the physical examination showed no arterial pulses in the affected vessels. Arterial Doppler confirmed signs of diffuse arterial spasm in all of them. An arteriography was performed to the second patient and it showed obliteration of the distal sector of the ulnar and radial arteries. Ergotism secondary to ergotamine-ritonavir association was diagnosed. Patients were treated discontinuing the administration of involved drugs, arterial vasodilators and prophylactic anticoagulation, with marked improvement of symptoms.

[Ergotism secondary to ergotamine-ritonavir association. Report of three cases]. / Ergotismo secundario a la asociación ergotamina-ritonavir. A propósito de 3 casos.

Ergotism is a complication of the acute intoxication or chronic abuse of ergot derivatives. It may be manifested by a vasomotor syndrome with peripheral vascular disease frequently involving extremities. We report three patients infected with human immunodeficiency virus (HIV), in antiretroviral treatment (ART) that included a protease inhibitor as ritonavir, and had received self-medicated ergotamine. They developed symptoms of peripheral vascular disease and the physical examination showed no arterial pulses in the affected vessels. Arterial Doppler confirmed signs of diffuse arterial spasm in all of them. An arteriography was performed to the second patient and it showed obliteration of the distal sector of the ulnar and radial arteries. Ergotism secondary to ergotamine-ritonavir association was diagnosed. Patients were treated discontinuing the administration of involved drugs, arterial vasodilators and prophylactic anticoagulation, with marked improvement of symptoms.

Ergotamine-induced lower extremity arterial vasospasm presenting as acute limb ischemia.

Ergotamine-induced limb ischemia is rare and usually results from an accidental overdose. Several agents, including erythromycin and tetracycline, raise serum ergotamine levels and augment its effect. We present a case of acute lower limb ischemia with characteristic angiography findings of diffuse arterial spasm resulting from use of ergotamine and an erythromycin derivative, clarithromycin. The history of the patient and classic features seen on angiography helped us establish the diagnosis. The patient was successfully treated with low molecular heparin and epidural infusion of bupivacain. Since ergot vasospasm is a self limited and medically treatable condition, interventional radiologists must be aware of ergotamine-induced acute limb ischemia to avoid any unnecessary interventional procedures, unless necrosis and gangrene are imminent.

[Medical relevance of mycotoxins]. / Medizinische Relevanz der Mykotoxine.

There are many mycotoxins with different chemical structures and biological activities. They are present in many food items of vegetable and animal origin as well as in the air. Consequently the exposure of humans to these agents is rather common. In some particular instances the dosage taken up by the body may be considerable. The various biological effects of mycotoxins such as organ toxicity, mutagenicity, carcinogenicity, teratogenicity and modulation of the immune system are well documented by in vitro and animal experiments. Furthermore, cases of intoxication by mycotoxins are well known in veterinary medicine. However, the relevance of mycotoxins in human medicine remains largely underestimated, because material from patients with characteristic symptoms is rarely tested for mycotoxins.

[A case of homicide by ergotamine poisoning]. / Przypadek zabójstwa przez zatrucie ergotamina.

The report presents a rare case of homicide. A mummified body of a man was found bricked up in the kitchen. Toxicological examination revealed high concentration levels of ergotamine in the internal organs and blood.

Irreversible coma, ergotamine, and ritonavir.

We report the first case in the medical literature (to our knowledge) of a patient with human immunodeficiency virus infection who was being treated with ritonavir and developed signs of severe vascular involvement and irreversible coma after the administration of 3 mg of ergotamine tartrate.

Endocrine and respiratory responses to ergotamine in Brahman and Hereford steers.

Ergot alkaloids are considered causative agents of fescue toxicosis, a syndrome experienced by cattle consuming tall fescue (Festuca arundinacea) infected with the fungal endophyte Neotyphodium coenophialum. One sign of fescue toxicosis in cattle is severe hyperthermia. This study assessed hormonal responses to ergotamine in heat-sensitive and heat-tolerant cattle. Seven Hereford (heat-sensitive, Bos taurus) and 7 Brahman (heat-tolerant, Bos indicus) steers on a fescue-free diet received ergotamine tartrate iv. Blood was sampled every 15 min for 2 h before and 4 h after dosing for determination of circulating hormonal changes. Respiration rates were recorded hourly. Ambient temperature and relative humidity averaged 31C and 48%, respectively, during sampling. A breed x time interaction existed (p < 0.01) for plasma prolactin, LH, insulin, glucagon, cortisol, triiodothyronine and glucose concentrations. The breed x time interaction tended to affect (p = 0.14) growth hormone and influenced (p < 0.01) respiration rates. Ergotamine reduced (p < 0.01) plasma LH and increased (p < 0.01) growth hormone concentrations in Brahman. Both breeds responded to ergotamine with increased (p < 0.01) plasma cortisol, glucagon, and glucose and reduced (p < 0.01) insulin concentrations. The magnitude of response for cortisol, insulin, and glucose were greater for the Brahman. Ergotamine increased (p < 0.01) plasma triiodothyronine and respiration rates in Hereford, whereas these traits were unaltered in Brahman. Acute ergotamine exposure generally resulted in similar effects on Brahman and Hereford steers. The triiodothyronine and respiratory comparisons revealed modified responses in Brahman that suggest a potential benefit of using heat-tolerant genetics to reduce the adverse effects of fescue toxicosis in cattle.

Eficacia de la PGE1 en el tratamiento de la intoxicación crónica por ergotamina / Effectiveness of PGE1 for the treatment of chronic poisoning byergotamine

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Ergotism related to a single dose of ergotamine tartrate in an AIDS patient treated with ritonavir.

We report a rare case of ergotism related to a single dose of ergotamine tartrate in a man with AIDS being treated with ritonavir. He was treated with a prostacyclin analogue and made a complete recovery.

Severe reversible arterial spasm with ergotamine.

A patient is described with marked unilateral arterial spasm of the proximal vessels and severe ischaemia of the left foot as a result of excessive use of ergotamine tartrate. Treatment with intravenous heparin infusion followed by chemical sympathectomy was successful.

Erythromycin-associated ergotamine intoxication: arteriographic and electrophysiologic analysis of a rare cause of severe ischemia of the lower extremities and associated ischemic neuropathy.

Vasospasm associated with ergotamine is a well-known phenomenon. In this case report we present a rare drug interaction between erythromycin and ergotamine at normal doses causing lower extremity ischemia in a 36-year-old woman. Nitroprusside proved to be the treatment of choice. The response was dramatic and took place in a matter of hours in this patient. Ischemic monomelic neuropathy is a recently described entity in which axonal necrosis is caused by a loss of distal extremity blood flow. The association between erythromycin and ergotamine may be a dangerous pharmacologic combination; drugs that have a hepatic cycle with ergotamine derivatives must be used with caution.

Effects of hydrated sodium calcium aluminosilicate on fescue toxicosis and mineral absorption.

The possibility of supplementing livestock diets with an aluminosilicate to protect them from fescue toxicosis was investigated. An in vitro study showed that hydrated sodium calcium aluminosilicate (HSCAS) removed greater than 90% of the ergotamine from aqueous solutions at pH 7.8 or lower, indicating a high affinity of ergotamine for HSCAS in vitro. Rats fed diets containing tall fescue seed infested (E+) with the endophytic fungus Acremonium coenophialum had lower (P less than .05) feed intakes and weight gains than did rats fed diets containing uninfested (E-) tall fescue seed. When feed intake by rats fed the E- seed diet was limited to that of rats fed the E+ seed diet, weight gains did not differ, but testes weights and serum prolactin (PRL) concentrations were lower (P less than .05 and .10, respectively) in rats receiving E+ seed. Supplementing E+ seed diets with HSCAS did not eliminate effects of E+ seed on intake, PRL, or testes weights. Sheep fed E+ tall fescue hay had higher (P less than .05) rectal temperatures than did sheep fed an equal amount of E- tall fescue hay, but OM and N digestion coefficients did not differ between the two hays. Supplementing E+ hay diets with HSCAS did not eliminate the effect of E+ hay on rectal temperatures. Addition of 2% HSCAS to tall fescue hay diets did not affect apparent absorption by sheep of OM, N, Ca, P, Na, K, or Cu, but it reduced (P less than .05) the apparent absorption of Mg, Mn, and Zn.(ABSTRACT TRUNCATED AT 250 WORDS)