Drug interactions
Dihydroergotamine + Miconazole
Severity: Major
Dihydroergotamine and Miconazole: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Dihydroergotamine is cleared mainly by CYP3A4, and strong inhibition of this enzyme can raise ergot levels sharply, causing ergotism with severe peripheral and cerebral vasospasm and ischemia. Miconazole is a CYP3A4 inhibitor and, although vaginal absorption is low, systemic exposure can occur and ergot toxicity is potentially catastrophic.
What this interaction means in plain words
Dihydroergotamine and Miconazole can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Dihydroergotamine belongs to Central Nervous System; Miconazole belongs to Anti Fungals.
Why it happens
Miconazole inhibits CYP3A4-mediated metabolism of dihydroergotamine, increasing its systemic concentrations.
What to do
Avoid the combination where possible, and prefer a topical antifungal with minimal absorption or an alternative to the ergot. If used together, counsel the patient to report numbness, cold or painful extremities, or chest pain immediately.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Miconazole
Other interactions of Dihydroergotamine
- Almotriptan + Dihydroergotamine Contraindicated
- Clarithromycin + Dihydroergotamine Contraindicated
- Dihydroergotamine + Dopamine Contraindicated
- Dihydroergotamine + Dronedarone Contraindicated
- Dihydroergotamine + Efavirenz Contraindicated
- Dihydroergotamine + Eletriptan Contraindicated
Frequently asked questions
Can I take Dihydroergotamine with Miconazole?
MediHelp rates the interaction as major. Dihydroergotamine and Miconazole can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Dihydroergotamine is cleared mainly by CYP3A4, and strong inhibition of this enzyme can raise ergot levels sharply, causing ergotism with severe peripheral and cerebral vasospasm and ischemia. Miconazole is a CYP3A4 inhibitor and, although vaginal absorption is low, systemic exposure can occur and ergot toxicity is potentially catastrophic.
How serious is the interaction between Dihydroergotamine and Miconazole?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible, and prefer a topical antifungal with minimal absorption or an alternative to the ergot. If used together, counsel the patient to report numbness, cold or painful extremities, or chest pain immediately.
What other medicines interact with Miconazole?
MediHelp also lists interactions of Miconazole with, for example, Cabazitaxel, Dihydroergotamine intranasal, Ergotamine. The full list is on the Miconazole page.
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