Medicine name: GRAVERGOL
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(Also Known As: ERGOTAMINE, CAFFEINE, DIMENHYDRINATE)
* = GENERIC.
||1 mg/100 mg/50 mg
||$127.85 ||CanAm Drugs
||1 mg/100 mg/50 mg
||$129.07 ||CanAm Drugs
||* $13.24 ||CanAm Drugs
||* $13.74 ||CanAm Drugs
||100 mg/50 mg/1 mg
||$141.81 ||CanAm Drugs
* indicates generic
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Proper Use of This Medicine
Use this medicine only as directed by your doctor. Do not use more of it, and do not use it more often, than directed. If the amount you are to use does not relieve your headache, check with your doctor. Taking too much dihydroergotamine or ergotamine, or taking it too often, may cause serious effects, especially in elderly patients. Also, if a headache medicine (especially ergotamine) is used too often for migraines, it may lose its effectiveness or even cause a type of physical dependence. If this occurs, your headaches may actually get worse.
This medicine works best if you:
- Use it at the first sign of headache or migraine attack. If you get warning signals of a coming migraine, take it before the headache actually starts.
- Lie down in a quiet, dark room until you are feeling better.
Your doctor may direct you to take another medicine to help prevent headaches. It is important that you follow your doctor's directions, even if your headaches continue to occur. Headache-preventing medicines may take several weeks to start working. Even after they do start working, your headaches may not go away completely. However, your headaches should occur less often, and they should be less severe and easier to relieve. This can reduce the amount of dihydroergotamine, ergotamine, or pain relievers that you need. If you do not notice any improvement after several weeks of headache-preventing treatment, check with your doctor.
For patients using dihydroergotamine:
- Dihydroergotamine is given only by injection. Your health care professional will teach you how to inject yourself with the medicine. Be sure to follow the directions carefully. Check with your health care professional if you have any problems using the medicine.
For patients using the sublingual (under-the-tongue) tablets of ergotamine:
- To use Place the tablet under your tongue and let it remain there until it disappears. The sublingual tablet should not be chewed or swallowed, because it works faster when it is absorbed into the body through the lining of the mouth. Do not eat, drink, or smoke while the tablet is under your tongue.
For patients using rectal suppository forms of a headache medicine:
- If the suppository is too soft to use, chill it in the refrigerator for 30 minutes or run cold water over it before removing the foil wrapper.
- If you have been directed to use part of a suppository, you should divide the suppository into pieces that all contain the same amount of medicine. To do this, use a sharp knife and carefully cut the suppository lengthwise (from top to bottom) into pieces that are the same size. The suppository will be easier to cut if it has been kept in the refrigerator.
- To insert the suppository First remove the foil wrapper and moisten the suppository with cold water. Lie down on your side and use your finger to push the suppository well up into the rectum.
The dose of these headache medicines will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.
- Adults: For relieving a migraine or cluster headache 1 mg. If your headache is not better, and no side effects are occurring, a second 1-mg dose may be used at least one hour later.
- Children 6 years of age and older: For relieving a migraine headache It is not likely that a child will be receiving dihydroergotamine at home. If a child needs the medicine, the dose will have to be determined by the doctor.
- Some headache medicines contain only ergotamine. Some of them contain other medicines along with the ergotamine. The number of tablets, capsules, or suppositories that you need for each dose depends on the amount of ergotamine in them. The size of each dose, and the number of doses that you take, also depends on the reason you are taking the medicine and on how you react to the medicine.
- For oral (capsule or tablet) and sublingual (under-the-tongue tablet) dosage forms:
- For relieving a migraine or cluster headache 1 or 2 mg of ergotamine. If your headache is not better, and no side effects are occurring, a second dose and even a third dose may be taken; however the doses should be taken at least 30 minutes apart. People who usually need more than one dose of the medicine, and who do not get side effects from it, may be able to take a larger first dose of not more than 3 mg of ergotamine. This may provide better relief of the headache with only one dose. The medicine should not be taken more often than 2 times a week, at least five days apart.
- For preventing cluster headaches The dose of ergotamine, and the number of doses you need every day, will depend on how many headaches you usually get each day. For some people, 1 or 2 mg of ergotamine once a day may be enough. Other people may need to take 1 or 2 mg of ergotamine 2 or 3 times a day.
- For all uses Do not take more than 6 mg of ergotamine a day in the form of capsules or tablets.
- Children 6 years of age and older: For relieving migraine headaches 1 mg of ergotamine. If the headache is not better, and no side effects are occurring, a second dose and even a third dose may be taken; however, the doses should be taken at least 30 minutes apart. Children should not take more than 3 mg of ergotamine a day in the form of capsules or tablets. Also, this medicine should not be taken more often than 2 times a week, at least five days apart.
- For rectal suppository dosage forms:
- Adults: For relieving migraine or cluster headaches Usually 1 mg of ergotamine, but the dose may range from half of this amount to up to 2 mg. If your headache is not better, and no side effects are occurring, a second dose and even a third dose may be used; however the doses should be taken at least 30 minutes apart. People who usually need more than one dose of the medicine, and who do not get side effects from it, may be able to use a larger first dose of not more than 3 mg. This may provide better relief of the headache with only one dose. Adults should not use more than 4 mg of ergotamine a day in suppository form. Also, this medicine should not be used more often than 2 times a week, at least five days apart.
- Children 6 years of age and older: For relieving migraine headaches One-half or 1 mg of ergotamine. Children should not receive more than 1 mg a day of ergotamine in suppository form. Also, this medicine should not be used more often than 2 times a week, at least five days apart.
To store this medicine:
- Keep out of the reach of children since overdose is especially dangerous in children.
- Store away from heat and direct light.
- Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
- Suppositories should be stored in a cool place, but not allowed to freeze. Some manufacturers recommend keeping them in a refrigerator; others do not. Follow the directions on the package. However, cutting the suppository into smaller pieces, if you need to do so, will be easier if the suppository is kept in the refrigerator.
- Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.
Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For these headache medicines, the following should be considered:
Allergies Tell your doctor if you have ever had any unusual or allergic reaction to atropine, belladonna, pentobarbital or other barbiturates, caffeine, dimenhydrinate, diphenhydramine, or an ergot medicine. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.
Pregnancy Use of dihydroergotamine or ergotamine by pregnant women may cause serious harm, including death of the fetus and miscarriage. Therefore, these medicines should not be used during pregnancy.
- For dihydroergotamine and ergotamine: These medicines pass into the breast milk and may cause unwanted effects, such as vomiting, diarrhea, weak pulse, changes in blood pressure, or convulsions (seizures) in nursing babies. Large amounts of these medicines may also decrease the flow of breast milk.
- For caffeine: Caffeine passes into the breast milk. Large amounts of it may cause the baby to appear jittery or to have trouble in sleeping.
- For belladonna alkaloids, dimenhydrinate, and diphenhydramine: These medicines have drying effects. Therefore, it is possible that they may reduce the amount of breast milk in some people. Dimenhydrinate passes into the breast milk.
- For pentobarbital: Pentobarbital passes into the breast milk. Large amounts of it may cause unwanted effects such as drowsiness in nursing babies.
Be sure that you discuss these possible problems with your doctor before taking any of these medicines.
- For dihydroergotamine and ergotamine: These medicines are used to relieve severe, throbbing headaches in children 6 years of age or older. They have not been shown to cause different side effects or problems in children than they do in adults. However, these medicines can cause serious side effects in any patient. Therefore, it is especially important that you discuss with the child's doctor the good that this medicine may do as well as the risks of using it.
- For belladonna alkaloids: Young children, especially children with spastic paralysis or brain damage, may be especially sensitive to the effects of belladonna alkaloids. This may increase the chance of side effects during treatment.
- For dimenhydrinate, diphenhydramine, and pentobarbital : Although these medicines often cause drowsiness, some children become excited after taking them.
- For dihydroergotamine and ergotamine: The chance of serious side effects caused by decreases in blood flow is increased in elderly people receiving these medicines.
- For belladonna alkaloids, dimenhydrinate, diphenhydramine, and pentobarbital: Elderly people are more sensitive than younger adults to the effects of these medicines. This may increase the chance of side effects such as excitement, depression, dizziness, drowsiness, and confusion.
Other medicines Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Many medicines can add to or decrease the effects of the belladonna alkaloids, caffeine, dimenhydrinate, diphenhydramine, or pentobarbital present in some of these headache medicines. Therefore, you should tell your health care professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine. This is especially important if any medicine you take causes excitement, trouble in sleeping, dryness of the mouth, dizziness, or drowsiness.
When you are taking dihydroergotamine or ergotamine, it is especially important that your health care professional know if you are taking any of the following:
- Cocaine or
- Epinephrine by injection [e.g., Epi-Pen] or
- Other ergot medicines (ergoloid mesylates [e.g., Hydergine], ergonovine [e.g., Ergotrate], methylergonovine [e.g., Methergine], methysergide [e.g., Sansert]) The chance of serious side effects caused by dihydroergotamine or ergotamine may be increased
- Itraconazole (e.g., Sporanox)
- Ketoconazole (e.g., Nizoral)
- Macrolide antibiotics (clarithromycin [e.g., Biaxin], erythromycin [e.g., Ery-Tab], troleandomycin [e.g., TAO])
- Protease inhibitors (indinavir [e.g., Crixivan], nelfinavir [e.g., Viracept], ritonavir [e.g., Norvir]) Use of any of these medicines with ergotamine can cause serious or life-threatening problems with blood circulation.
- 5-HT1 agonists (almotriptan [e.g., Axert], eletriptan [e.g., Relpax], frovatriptan [e.g., Frova], naratriptan [e.g., Amerge], rizatriptan [e.g., Maxalt], sumatriptan [e.g., Imitrex], zolmitriptan [e.g., Zomig]) Use of these medicines may cause serious side effects if taken within 24 hours of an ergot-containing medicine.
Other medical problems
The presence of other medical problems may affect the use of these headache medicines. Make sure you tell your doctor if you have any other medical problems, especially:
- Agoraphobia (fear of open or public places) or
- Panic attacks or
- Stomach ulcer or
- Trouble in sleeping (insomnia) Caffeine can make your condition worse
- Diarrhea Rectal dosage forms (suppositories) will not be effective if you have diarrhea
- Difficult urination or
- Enlarged prostate or
- Glaucoma (not well controlled) or
- Heart or blood vessel disease or
- High blood pressure (not well controlled) or
- Infection or
- Intestinal blockage or other intestinal problems or
- Itching (severe) or
- Kidney disease or
- Liver disease or
- Mental depression or
- Overactive thyroid or
- Trauma from an accident (broken arm or leg)
- Urinary tract blockage The chance of side effects may be increased
Also, tell your doctor if you need, or if you have recently had, an angioplasty (a procedure done to improve the flow of blood in a blocked blood vessel) or surgery on a blood vessel. The chance of serious side effects caused by dihydroergotamine or ergotamine may be increased.