Drug interactions
Ergotamine + Nirmatrelvir / ritonavir
Severity: Contraindicated
Ergotamine and Nirmatrelvir / ritonavir: contraindicated interaction.
Last updated Sources: US FDA label
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
Ritonavir in this combination strongly inhibits CYP3A, markedly raising ergotamine levels. Severe ergotism with vasospasm and ischemia of extremities and other tissues has been reported with ritonavir and ergot derivatives.
What this interaction means in plain words
Ergotamine and Nirmatrelvir / ritonavir are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two.
Why it happens
Potent CYP3A4 inhibition by ritonavir reduces ergotamine clearance.
What to do
Contraindicated; hold ergotamine during and for several days after the nirmatrelvir/ritonavir course and use a non-ergot alternative.
What to ask your pharmacist
- Is there an alternative to one of these two medicines for me?
- If both are essential, who is monitoring me and how often?
- Which symptoms mean I should stop and seek help straight away?
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References
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 Ergotamine with Nirmatrelvir / ritonavir?
MediHelp rates the interaction as contraindicated. Ergotamine and Nirmatrelvir / ritonavir are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two. Ritonavir in this combination strongly inhibits CYP3A, markedly raising ergotamine levels. Severe ergotism with vasospasm and ischemia of extremities and other tissues has been reported with ritonavir and ergot derivatives.
How serious is the interaction between Ergotamine and Nirmatrelvir / ritonavir?
MediHelp rates it contraindicated, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Contraindicated; hold ergotamine during and for several days after the nirmatrelvir/ritonavir course and use a non-ergot alternative.
What other medicines interact with Ergotamine?
MediHelp also lists interactions of Ergotamine with, for example, Almotriptan, Atazanavir, Clarithromycin. The full list is on the Ergotamine page.
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