Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ergot's derivatives are widely used to treat and prevent migraine and, associated with heparin, for the prevention of deep vein thrombosis. During a five-year period, 7 patients have been admitted in our hospital for severe vasospasm of one or several extremities due to ergot's derivatives. All patients presented with acute severe ischemia of the lower limb requiring iv infusion of vasodilator drugs. Ergotamine tartrate was the responsible drug in four patients and dihydroergotamine(DHE)-heparin in three patients. Intravenous administration of sodium nitroprusside (n = 6) relieved vasospasm in all but one of the patients within hours to days and no amputation was required. Ankle or great toe to arm systolic pressure index was normalized in the majority of the patients after treatment. A sympathectomy was performed in two patients which did not improve the clinical course. Distal necrosis developed in two patients (DHE-heparin). It is concluded that incidence of severe ergotism is less than 0.5/100,000/year in Geneva. This contrasts with the high prevalence (15%) of subclinical ergotism reported by others. No amputation was required in this series in spite of severe and prolonged vasospasms. Subclinical ergotism most probably precedes for weeks the onset of severe vasospasm, which calls for close monitoring of patients taking ergot's derivatives.
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PMID:Severe iatrogenic ergotism: incidence and clinical importance. 190 11

Ergotamine tartrate and caffeine has been widely prescribed for the prevention and treatment of migraine headaches. Rarely the ergotamine can cause symptoms of peripheral vascular insufficiency, often concerning the lower extremities. A case report of bilateral severe ischemia to the upper limbs, caused by a chronic assumption of ergotamine tartrate is presented.
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PMID:Spasm of arm arteries due to ergotamine tartrate. A case report. 207 75

Ergotamine tartrate (ET) and dihydroergotamine mesylate (DHE) have been widely and effectively used in the treatment of migraine for many decades, although few randomized, controlled clinical trials have been conducted with these compounds. To compare their safety profiles, the world literature on the two agents was surveyed. The results are summarized, along with a critical analysis of the strengths and limitations of the various sources of safety data (in vitro research, animal studies, Phase I and II studies, controlled clinical trials, and postmarketing surveillance). Significant pharmacologic and safety differences exist between ET and DHE. Dihydroergotamine mesylate is a less potent arterial vasoconstrictor than ET, although nearly equipotent as a venoconstrictor. It is a more potent alpha-adrenergic antagonist, but is much less emetic, has less effect on the uterus, and is not associated with rebound headache. Adverse effects associated with ET (which are often due to excessive dosage and/or chronic usage) include nausea, acroparesthesia, ischemia, habituation and overuse headache, and, rarely, overt ergotism. Reports of serious adverse effects following recommended doses of DHE are rare. As with most antimigraine drugs, the most frequent adverse effect with intravenous (i.v.) DHE is nausea; however, following intramuscular (i.m.) or intranasal (IN) administration, the incidence of nausea is low and concomitant administration of an antiemetic is not needed. In patients without contraindications, both DHE and ET are safe and effective when used in recommended doses. Nearly 50 years of clinical experience without major safety problems allows a high level of confidence in their clinical use.
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PMID:Ergotamine tartrate and dihydroergotamine mesylate: safety profiles. 900 72

A 29-year-old woman presented with severe leg pain that had lasted for several weeks. During that period, she had taken painkillers in order to achieve sleep. In the week before she was admitted to hospital, she had noticed numbness and a cold feeling below her knees. There were no arterial pulsations below her groin, the skin of her legs being cold and pale. She had a history of chronic daily headache and had ingested Cafergot compound corresponding to ergotamine 2 to 3 mg daily for the previous 2 or 3 months. Angiography demonstrated severe narrowing of both superficial femoral arteries for a distance of about 5 to 6 cm and a subtotal stenosis of the right popliteal artery. After discontinuation of ergotamine, the patient's symptoms gradually disappeared within a few days. Angiography was repeated 2 days after the first examination and demonstrated regression of the spasms in the femoral arteries and reestablished flow in the distal vessels. Ergotamine tartrate can induce life-threatening ischemia of an extremity. Discontinuation of ergotamine is usually sufficient to reverse the ischemia, however, intravenous infusion of sodium nitroprusside may occasionally be necessary to avoid limb amputation.
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PMID:Limb-threatening ischemia due to ergotamine: case report with angiographic evidence. 1075 38