ERGOTAMINE, CAFFEINE, BELLADONNA & PENTOBARBITAL

Brand & Generic Names

Cafergot-PB

Basic Information

• Habit forming? Yes
• Prescription needed? Yes
• Available as generic? No
• Drug class: Vasoconstrictor, stimulant (xanthine), sedative, antispasmodic

Uses

• Relieves pain of migraines and other headaches caused by dilated blood vessels. Will not prevent headaches.
• Reduces anxiety or nervous tension (low dose).

Dosage & Usage Information

How to take:
Tablet--Swallow with liquid, or let dissolve under tongue. If you can't swallow whole, crumble tablet and take with liquid or food.
Suppositories--Remove wrapper and moisten suppository with water. Gently insert larger end into rectum. Push well into rectum with finger.
Lie down in quiet, dark room after taking.

When to take:
At first sign of vascular or migraine headache.

If you forget a dose:
Take as soon as you remember up to 2 hours late. If more than 2 hours, wait for next scheduled dose (don't double this dose).

What drug does:
Blocks nerve impulses at parasympathetic nerve endings, preventing muscle contractions and gland secretions of organs involved.
May partially block nerve impulses at nerve cell connections.
Constricts blood vessel walls.
Stimulates central nervous system.

Time lapse before drug works:
15 to 30 minutes.

Don't take with:
Non-prescription drugs without consulting doctor.
Any other medicine without consulting your doctor or pharmacist.

Overdose

SYMPTOMS:
Tingling, cold extremities and muscle pain. Progresses to nausea, vomiting, diarrhea, insomnia, cold skin, rapid and weak pulse, severe numbness of extremities, confusion, convulsions, coma.

WHAT TO DO:

• Dial 911 (emergency) or O (operator) for an ambulance or medical help. Then give first aid immediately.
• See EMERGENCY Information.

Possible Adverse Reactions or Side Effects

Life-threatening:

In case of overdose, see Overdose section.

Common:

• Moderately fast heartbeat.
• Dizziness, nausea, diarrhea, vomiting, nervousness, "hangover" effect, increased frequency or severity of headaches.

Infrequent:

• Itchy skin; rash; abdominal pain; cold hands and feet; weakness in arms, back, legs; confusion; irritability; indigestion; low blood sugar with weakness and trembling.
• Nasal congestion, altered taste.

Rare:

Anxiety; red or purple blisters, especially in hands and feet; change in vision; extreme thirst; numbness or tingling in hands or feet; jaundice.

Warnings & Precautions

Don't take if:

• You are allergic to any stimulant, ergot preparation, barbiturate or anticholinergic.
• You have heart disease, peptic ulcer of stomach or duodenum, porphyria, trouble with stomach bloating, difficulty emptying your bladder completely, narrow-angle glaucoma, severe ulcerative colitis.

Before you start, consult your doctor:

• If you have hypoglycemia (low blood sugar), an infection, angina, heart problems, high blood pressure, hardening of the arteries, vein problems, kidney or liver disease, epilepsy, asthma, anemia, chronic pain, open-angle glaucoma, chronic bronchitis, hiatal hernia, enlarged prostate, myasthenia gravis, peptic ulcer.
• If you plan to become pregnant within medication period.
• If you will have surgery within 2 months, including dental surgery, requiring general or spinal anesthesia.

Over age 60:
Adverse reactions and side effects may be more frequent and severe than in younger persons, especially dizziness and excessive potassium loss.

Pregnancy:
Risk to unborn child outweighs drug benefits. Don't use.

Breast-feeding:
Drug filters into milk. May harm child. Avoid.

Infants & children:
Not recommended.

Prolonged use:

• Stomach ulcers.
• Cold skin, muscle pain, gangrene of hands and feet. This medicine not intended for uninterrupted use.
• May cause addiction, anemia, chronic intoxication.
• May lower body temperature, making exposure to cold temperatures hazardous.
• Chronic constipation, possible fecal impaction.

Skin & sunlight:
May cause rash or intensify sunburn in areas exposed to sun or sunlamp.

Driving, piloting or hazardous work:
Don't drive or pilot aircraft until you learn how medicine affects you. Don't work around dangerous machinery. Don't climb ladders or work in high places. Danger increases if you drink alcohol or take medicine affecting alertness and reflexes, such as antihistamines, tranquilizers, sedatives, pain medicine, narcotics and mind-altering drugs.

Discontinuing:
May be unnecessary to finish medicine. Follow doctor's instructions. If you develop withdrawal symptoms of hallucinations, headache, agitation or sleeplessness after discontinuing, call doctor right away.

Others:

• Great potential for abuse.
• May produce or aggravate fibrocystic breast disease in women.
• Impaired blood circulation can lead to gangrene in intestines or extremities. Never exceed recommended dose.

Possible Interaction with Other Drugs

GENERIC NAME	COMBINED EFFECT
------------------------	-----------------------
Amantadine	Increased belladonna effect.
Amphetamines*	Dangerous blood pressure rise.
Anticoagulants*,	Decreased anti-
oral	coagulant effect.
Anticonvulsants*	Changed seizure patterns.
Antidepressants,	Decreased anti-
tricyclics (TCA)*	depressant effect. Possible
	dangerous oversedation.
Antidiabetics*, oral	Increased pentobarbital effect.
Antihistamines*	Dangerous sedation. Avoid.
Aspirin	Decreased aspirin effect.
Beta-adrenergic	Decreased effect of
blockers*	beta-adrenergic blocker.
Cimetidine	Increased caffeine effect.
Contraceptives*,	Decreased contraceptive
oral	effect.
Cortisone drugs*	Decreased cortisone effect.
	Increased internal eye pressure.
Digitoxin	Decreased digitoxin effect.
Disulfiram	Possible increased pentobarbital
	effect.
Doxycycline	Decreased doxycycline effect.
Dronabinol	Increased effect of drugs.
Ephedrine	Dangerous blood pressure rise.
Epinephrine	Dangerous blood pressure rise.
Erythromycin	Decreased ergotamine effect.
Estrogens*	Decreased estrogen effect.
Griseofulvin	Possible decreased griseofulvin
	effect.
Guanethidine	Decreased belladonna effect.
Haloperidol	Increased internal eye pressure.
Indapamide	Increased indapamide effect.
Isoniazid	Increased caffeine effect.
MAO inhibitors*	Increased belladonna effect,
	dangerous blood pressure rise.
Meperidine	Increased belladonna effect.
Methylphenidate	Increased belladonna effect.
Metoclopramide	May decrease metoclopramide effect.
Metronidazole	Possible decreased metronidazole
	effect.
Mind-altering	Dangerous sedation.
drugs*	Avoid.
Narcotics*	Dangerous sedation. Avoid.
Nitrates*	Increased internal eye pressure.
Nitroglycerin	Decreased nitroglycerin effect.
Non-steroidal	Decreased anti-inflammatory effect.
Orphenadrine	Increased belladonna effect.
Pain relievers*	Dangerous sedation. Avoid.
Phenothiazines*	Increased belladonna effect.
Pilocarpine	Loss of pilocarpine effect in
	glaucoma treatment.
Potassium	Possible intestinal
supplements*	ulcers with oral potassium tablets.
Quinidine	Increased belladonna effect.
Reserpine	Decreased belladonna effect.
Rifampin	Possible decreased pentobarbital
	effect.
Sedatives*	Dangerous sedation. Avoid.
Sleep inducers*	Dangerous sedation. Avoid.
Sumatriptan	Increased vasoconstriction. Delay
	24 hours between drugs.
Sympathomimetics*	Overstimulation, blood pressure
	rise.
Thyroid hormones*	Increased thyroid effect.
Tranquilizers*	Dangerous sedation. Avoid.
Troleandomycin	Increased adverse reactions of
	ergotamine.
Valproic acid	Increased pentobarbital effect.
Vitamin C	Decreased belladonna effect. Avoid
	large doses of vitamin C.

Possible Interaction with Other Substances

INTERACTS WITH	COMBINED EFFECT
---------------	---------------
Alcohol:	Dilates blood vessels. Makes
	headache worse. Possible fatal
	oversedation. Avoid.
Caffeine drinks.	May help relieve headache.
Cocaine:	Excessively rapid heartbeat. Avoid.
Any to which you	May make headache
are allergic.	worse. Avoid.
Marijuana:	Drowsiness and dry mouth, excessive
	sedation. Avoid. Occasional
	use--Cool extremities. Regular
	use--Persistent chill.
Tobacco:	Decreased effect of ergotamine.
	Makes headache worse.