and give the chance Ergoloid Mesylates Overview Side Effects Dosage Professional Interactions More Pregnancy Warnings User Reviews Drug Images Support Group Q & A Pricing & Coupons Pronunciation (ER goe loid MES i lates) Index Terms Dihydroergotoxine Dihydrogenated Ergot Alkaloids Hydergine [DSC] Slideshow 11 Signs of Alzheimer's Disease - Or Are You Just Getting Older? Dosage Forms Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Tablet, Oral: Generic: 1 mg Pharmacologic Category Ergot Derivative Pharmacology Ergoloid mesylates do not have the vasoconstrictor effects of the natural ergot alkaloids; exact mechanism in dementia is unknown; originally classed as peripheral and cerebral vasodilator, now considered a "metabolic enhancer"; there is no specific evidence that clearly establishes the mechanism by which ergoloid mesylate preparations produce mental effects, nor is there conclusive evidence that the drug particularly affects cerebral arteriosclerosis or cerebrovascular insufficiency. Absorption Rapid yet incomplete Metabolism Hepatic, including first-pass metabolism Time to Peak Serum: 1.5 to 3 hours Half-Life Elimination Serum: ~2.6 to 5.1 hours Use: Labeled Indications Mental capacity decline: Treatment of signs and symptoms of an idiopathic decline in mental capacity. Note: Individuals who do respond come from groups of patients who would be considered clinically to suffer from some ill-defined process related to aging or to have some underlying dementing condition (ie, primary progressive dementia, Alzheimer dementia, senile onset, multi-infarct dementia). Contraindications Hypersensitivity to ergoloid mesylates, ergot, or any component of the formulation; acute or chronic psychosis; concurrent use with potent inhibitors of cytochrome P450 (CYP-450) 3A4 (includes protease inhibitors, azole antifungals, and some macrolide antibiotics). Canadian labeling: Additional contraindications (not in US labeling): Severe bradycardia; severe hypotension. Documentation of allergenic cross-reactivity for ergot alkaloids is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty. Dosing: Adult Mental capacity decline: Oral: 1 mg 3 times daily; results may not be observed until 3 to 4 weeks. Dosing: Geriatric Avoid use in this age group due to lack of efficacy (Beers Criteria). Dosing: Renal Impairment There are no dosage adjustments provided in the manufacturer's labeling. Dosing: Hepatic Impairment There are no dosage adjustments provided in the manufacturer's labeling. Storage Store at 20 C to 25 C (68 F to 77 F). Drug Interactions Antiemetics (5HT3 Antagonists): May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Monitor therapy Antihepaciviral Combination Products: May increase the serum concentration of Ergot Derivatives. Avoid combination Anti-Parkinson Agents (Monoamine Oxidase Inhibitor): May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity if selegiline, rasagiline, or safinamide is combined with a serotonin modulator. Use of transdermal selegiline with serotonin modulators is contraindicated. Consider therapy modification Antipsychotic Agents: Serotonin Modulators may enhance the adverse/toxic effect of Antipsychotic Agents. Specifically, serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotic Agents may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Monitor therapy Aprepitant: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy Beta-Blockers: May enhance the vasoconstricting effect of Ergot Derivatives. Consider therapy modification Boceprevir: May increase the serum concentration of Ergoloid Mesylates. Avoid combination Chloroprocaine: May enhance the hypertensive effect of Ergot Derivatives. Monitor therapy Conivaptan: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Avoid combination CYP3A4 Inhibitors (Moderate): May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy CYP3A4 Inhibitors (Strong): May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors). Consider therapy modification Dapoxetine: May enhance the adverse/toxic effect of Serotonin Modulators. Avoid combination Dasatinib: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy Fosaprepitant: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Avoid combination Idelalisib: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Avoid combination Itraconazole: May increase the serum concentration of Ergoloid Mesylates. Avoid combination Ketoconazole (Systemic): May increase the serum concentration of Ergoloid Mesylates. Avoid combination Letermovir: May increase the serum concentration of Ergot Derivatives. Avoid combination Linezolid: May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Management: Due to a risk of serotonin syndrome/serotonin toxicity, discontinue serotonin modulators 2 weeks prior to the administration of linezolid. If urgent initiation of linezolid is needed, discontinue serotonin modulators immediately and monitor closely. Consider therapy modification Lorcaserin: May enhance the adverse/toxic effect of Ergot Derivatives. Specifically, use of these drugs together may increase the risk of developing valvular heart disease. Lorcaserin may enhance the serotonergic effect of Ergot Derivatives. This could result in serotonin syndrome. Avoid combination Macrolide Antibiotics: May increase the serum concentration of Ergot Derivatives. Cabergoline and Clarithromycin may interact, see specific monograph for full details. Exceptions: Azithromycin (Systemic); Fidaxomicin; Spiramycin. Consider therapy modification Metaxalone: May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Monitor therapy Methylene Blue: May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Avoid combination Methylphenidate: May enhance the adverse/toxic effect of Serotonin Modulators. Specifically, the risk of serotonin syndrome or serotonin toxicity may be increased. Monitor therapy Metoclopramide: Serotonin Modulators may enhance the adverse/toxic effect of Metoclopramide. This may be manifest as symptoms consistent with serotonin syndrome or neuroleptic malignant syndrome. Monitor therapy MiFEPRIStone: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Minimize doses of CYP3A4 substrates, and monitor for increased concentrations/toxicity, during and 2 weeks following treatment with mifepristone. Avoid cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus. Consider therapy modification Netupitant: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy Nitroglycerin: Ergot Derivatives may diminish the vasodilatory effect of Nitroglycerin. This is of particular concern in patients being treated for angina. Nitroglycerin may increase the serum concentration of Ergot Derivatives. Avoid combination Opioid Analgesics: May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Monitor therapy Palbociclib: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy Posaconazole: May increase the serum concentration of Ergoloid Mesylates. Avoid combination Protease Inhibitors: May increase the serum concentration of Ergot Derivatives. Avoid combination Reboxetine: May enhance the hypertensive effect of Ergot Derivatives. Monitor therapy Roxithromycin: May increase the serum concentration of Ergot Derivatives. Avoid combination Serotonin 5-HT1D Receptor Agonists: Ergot Derivatives may enhance the vasoconstricting effect of Serotonin 5-HT1D Receptor Agonists. Serotonin 5-HT1D Receptor Agonists may enhance the vasoconstricting effect of Ergot Derivatives. Avoid combination Serotonin Modulators: May enhance the adverse/toxic effect of other Serotonin Modulators. The development of serotonin syndrome may occur. Exceptions: Nicergoline; Tedizolid. Monitor therapy Simeprevir: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy Stiripentol: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Use of stiripentol with CYP3A4 substrates that are considered to have a narrow therapeutic index should be avoided due to the increased risk for adverse effects and toxicity. Any CYP3A4 substrate used with stiripentol requires closer monitoring. Consider therapy modification Tedizolid: May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Monitor therapy Telaprevir: May increase the serum concentration of Ergoloid Mesylates. Avoid combination TraMADol: Serotonin Modulators may enhance the adverse/toxic effect of TraMADol. The risk of seizures may be increased. TraMADol may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Monitor therapy Voriconazole: May increase the serum concentration of Ergoloid Mesylates. Avoid combination Adverse Reactions Frequency not defined. Adverse effects are minimal. Cardiovascular: Bradycardia, flushing, orthostatic hypotension Dermatologic: Skin rash Gastrointestinal: Gastrointestinal distress (sublingual administration), nausea (sublingual administration; transient) Local: Local irritation (sublingual administration) Ophthalmic: Blurred vision Respiratory: Nasal congestion Warnings/Precautions Concerns related to adverse effects: Cardiac valvular fibrosis: Ergot alkaloids have been associated with fibrotic valve thickening (eg, aortic, mitral, tricuspid); usually associated with long-term, chronic use. Pleural/retroperitoneal fibrosis: Rare cases of pleural and/or retroperitoneal fibrosis have been reported with prolonged daily use. Concurrent drug therapy issues: Drug-drug interactions: Additional potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult Drug Interactions for more detailed information. Other warnings/precautions: Appropriate use: Careful diagnosis should be attempted before prescribing. Because target symptoms are of unknown etiology, exclude potentially reversible and treatable conditions; particular care should be taken to exclude delirium and dementiform illness secondary to systemic disease, primary neurological disease, or primary disturbance of mood. Patient Education Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?) Patient may experience abdominal pain. Have patient report immediately to prescriber severe nausea or severe vomiting (HCAHPS). Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients. Next Interactions Print this page Add to My Med List More about ergoloid mesylates Side Effects During Pregnancy Dosage Information Drug Images Drug Interactions Support Group Pricing & Coupons En Español 0 Reviews Add your own review/rating Drug class: miscellaneous central nervous system agents Consumer resources Ergoloid mesylates Ergoloid mesylates Oral, Sublingual (Advanced Reading) Professional resources Ergoloid Tablets (FDA) Other brands: Hydergine Related treatment guides Alzheimer's Disease Arteriosclerotic Dementia Dementia} Drug Status Rx Availability Prescription only N Pregnancy Category Not classified N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Ergoloid mesylates Rating No Reviews - Be the first! 8.0 /10 No Reviews - Be the first! 8.0 Rate it! Manufacturer Sun Pharmaceutical Industries Inc. 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