Drug interactions
Diltiazem + Ergotamine
Severity: Major
Diltiazem and Ergotamine: 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
Diltiazem can markedly raise ergotamine concentrations, increasing the risk of ergotism with severe peripheral vasospasm, ischemia and cerebral ischemia. Serious cases have been reported with CYP3A4 inhibitors.
What this interaction means in plain words
Diltiazem and Ergotamine 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.
Diltiazem belongs to Cardiovascular; Ergotamine belongs to Central Nervous System.
Why it happens
Diltiazem inhibits CYP3A4-mediated first-pass and systemic metabolism of ergotamine.
What to do
Avoid the combination where possible and use a non-ergot migraine therapy. If unavoidable, monitor for numbness, coldness of extremities, and ischemic symptoms.
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 Diltiazem
- Diltiazem + Flibanserin Contraindicated
- Diltiazem + Ivabradine Contraindicated
- Diltiazem + Lomitapide Contraindicated
- Diltiazem + Lonafarnib Contraindicated
- Acebutolol + Diltiazem Major
- Alfentanil + Diltiazem Major
Other interactions of Ergotamine
- Almotriptan + Ergotamine Contraindicated
- Atazanavir + Ergotamine Contraindicated
- Clarithromycin + Ergotamine Contraindicated
- Cobicistat + Ergotamine Contraindicated
- Darunavir + Ergotamine Contraindicated
- Dihydroergotamine intranasal + Ergotamine Contraindicated
Frequently asked questions
Can I take Diltiazem with Ergotamine?
MediHelp rates the interaction as major. Diltiazem and Ergotamine 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. Diltiazem can markedly raise ergotamine concentrations, increasing the risk of ergotism with severe peripheral vasospasm, ischemia and cerebral ischemia. Serious cases have been reported with CYP3A4 inhibitors.
How serious is the interaction between Diltiazem and Ergotamine?
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 use a non-ergot migraine therapy. If unavoidable, monitor for numbness, coldness of extremities, and ischemic symptoms.
What other medicines interact with Diltiazem?
MediHelp also lists interactions of Diltiazem with, for example, Flibanserin, Ivabradine, Lomitapide. The full list is on the Diltiazem page.
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