Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
CAFERGOT vs ERGOMAR
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Ergotamine is a serotonin (5-HT1B/1D) receptor agonist that causes vasoconstriction of cranial blood vessels and inhibits neurogenic inflammation. Caffeine is a methylxanthine that enhances ergotamine absorption and may contribute to vasoconstriction.
Ergotamine acts as a partial agonist at serotonin 5-HT1B and 5-HT1D receptors, causing vasoconstriction of cranial blood vessels. It also inhibits norepinephrine reuptake and has alpha-adrenergic blocking activity.
Acute treatment of migraine headaches with or without aura,Acute treatment of cluster headache episodes
Abortive treatment of acute migraine headaches with or without aura,Cluster headache
1 to 2 tablets (each containing ergotamine tartrate 1 mg and caffeine 100 mg) orally at onset of migraine, then 1 tablet every 30 minutes as needed, maximum 6 tablets per attack or 10 tablets per week. Alternatively, 1 rectal suppository (ergotamine tartrate 2 mg and caffeine 100 mg) at onset, repeat once after 1 hour if needed, maximum 2 suppositories per attack or 5 per week.
Ergotamine tartrate 1-2 mg sublingually or orally at onset of migraine, then 1-2 mg every 30 minutes as needed, maximum 6 mg per attack and 10 mg per week.
2.5-3.9 hours (ergotamine); clinical context: t1/2 may be prolonged in hepatic impairment.
Terminal elimination half-life is approximately 2-3 hours for ergotamine, but clinical effects may persist longer due to active metabolites (e.g., ergotamine's half-life is 2.4 hours; metabolites have half-lives up to 10 hours).
Primarily hepatic via CYP3A4; ergotamine is extensively metabolized, and caffeine is metabolized via CYP1A2.
Primarily hepatic via CYP3A4; minor contributions from CYP2D6. Undergoes extensive first-pass metabolism.
Primarily hepatic metabolism and biliary excretion; less than 5% excreted unchanged in urine. Fecal elimination accounts for most of the administered dose.
Primarily hepatic metabolism with extensive biliary excretion; less than 5% excreted unchanged in urine. Fecal elimination accounts for approximately 30-40% of the dose as metabolites.
98-99% bound to plasma proteins, primarily albumin.
90-95% bound to plasma proteins, primarily albumin.
1.1-2.0 L/kg; clinical meaning: extensive tissue distribution, particularly into liver and spleen.
Approximately 0.4 L/kg (16-18 L in adults), indicating moderate tissue distribution.
Oral: <5% due to extensive first-pass metabolism; Sublingual: approximately 15-20%; Rectal: approximately 20-30%.
Sublingual: ~40-50%; Oral: <10% due to extensive first-pass metabolism; Rectal: ~25-30%.
Contraindicated in severe renal impairment. In moderate renal impairment (e GFR 30-59 m L/min/1.73 m²): use with caution; dose reduction not specifically defined but monitor for adverse effects. Mild impairment (e GFR ≥60 m L/min/1.73 m²): no adjustment needed.
GFR > 30 m L/min: No adjustment. GFR 10-30 m L/min: Caution; reduce dose by 50%. GFR < 10 m L/min: Contraindicated.
Contraindicated in Child-Pugh Class C. Child-Pugh Class A: no adjustment; Class B: use with caution, reduce dose by 50% and monitor. No specific dose recommendations from manufacturer; clinical judgment advised.
Child-Pugh A: Caution; reduce dose by 50%. Child-Pugh B: Contraindicated. Child-Pugh C: Contraindicated.
Not recommended for use in pediatric patients due to risk of ergotism and lack of safety data. No established weight-based dosing.
Not recommended for children under 12 years. Pediatric use not established; avoid use.
Use with caution due to increased risk of ergotism, renal/hepatic impairment, and drug interactions. Lower initial dose (e.g., 1 tablet) and careful monitoring. Avoid in patients over 65 with significant vascular disease.
Elderly patients are more sensitive to vasoconstriction; use lower initial dose (e.g., 1 mg) and monitor for adverse effects.
Serious and/or life-threatening peripheral ischemia has been associated with coadministration of ergotamine with potent CYP3A4 inhibitors (including protease inhibitors, macrolide antibiotics, and azole antifungals).
Serious and/or life-threatening peripheral ischemia and vasospasm have been associated with the concomitant use of ergotamine with potent CYP3A4 inhibitors including protease inhibitors, macrolide antibiotics, and azole antifungals.
Risk of ergotism (ischemia, gangrene) with prolonged use or overdosage,May cause vasospastic reactions, including coronary artery vasospasm and myocardial infarction,Rebound headache (medication overuse headache) with frequent use,Caffeine withdrawal may exacerbate headaches,Avoid concurrent use with potent CYP3A4 inhibitors
Risk of ischemic events (peripheral, cardiac, cerebral), fibrosis (retroperitoneal, pulmonary, cardiac), elderly patients (more sensitive to adverse effects), ergotism, drug interactions with CYP3A4 inhibitors, and prolonged use leading to medication-overuse headache.
Peripheral vascular disease,Coronary artery disease,Hypertension (uncontrolled),Sepsis,Severe hepatic or renal impairment,Pregnancy (Category X),Breastfeeding,Concurrent use of potent CYP3A4 inhibitors
Hypersensitivity to ergot alkaloids, peripheral vascular disease, coronary artery disease, uncontrolled hypertension, sepsis, hepatic or renal impairment, pregnancy, breastfeeding, concomitant use with potent CYP3A4 inhibitors, hemiplegic or basilar migraine.
Avoid excessive caffeine intake (e.g., coffee, tea, cola, energy drinks) as Cafergot contains caffeine and may cause additive stimulation or toxicity. Limit caffeine to no more than 200 mg per day during treatment.
Avoid grapefruit and grapefruit juice as they inhibit CYP3A4, increasing ergotamine levels and risk of toxicity. No other significant food interactions.
FDA Category X. First trimester: ergotamine is a potent vasoconstrictor and uterine stimulant, associated with increased risk of spontaneous abortion, congenital anomalies (including micrognathia, microphthalmia, cleft palate, and limb defects). Second and third trimesters: continued risk of uteroplacental insufficiency, intrauterine growth restriction, preterm labor, and fetal distress due to vasoconstriction and increased uterine tone.
Ergotamine (ERGOMAR) is contraindicated in pregnancy due to its oxytocic properties and potential for uterine hyperstimulation, fetal hypoxia, and congenital anomalies. First trimester: Increased risk of spontaneous abortion and major malformations (e.g., limb defects, CNS abnormalities) based on case reports. Second and third trimesters: Uterine hypertonicity and decreased placental perfusion leading to fetal distress, preterm labor, and low birth weight. Use only if benefit outweighs risk and no alternative; avoid in all trimesters.
Contraindicated during breastfeeding. Ergotamine reduces prolactin secretion and may suppress lactation. It is excreted into breast milk; M/P ratio not established. Reported infant adverse effects include vomiting, diarrhea, and seizures. Risk of vasospasm and ergotism in the infant.
Ergotamine is excreted into breast milk with a milk-to-plasma ratio of approximately 0.5-0.9. Potential for ergotism symptoms in infants (vomiting, diarrhea, seizures). It may also reduce milk production due to prolactin inhibition. Contraindicated during breastfeeding per manufacturer guidelines. If exposure occurs, monitor infant for symptoms and consider abrupt cessation.
Contraindicated in pregnancy; no dosing adjustments recommended. Use is not safe; alternative therapy should be sought.
Pregnancy may alter ergotamine pharmacokinetics (increased plasma volume, renal clearance, hepatic metabolism), but no established dose adjustment guidelines. Standard doses may be ineffective or toxic due to variable absorption. Avoid use if possible; if necessary, lowest effective dose for shortest duration, with close monitoring for toxicity.
Cafergot is ergotamine-caffeine combination for acute migraine. Avoid in pregnancy, uncontrolled hypertension, CAD, and peripheral vascular disease. Maximum dose: 6 tablets per attack or 10 tablets per week. Use at first sign of migraine. Not for prophylaxis. Can cause ergotism with prolonged use. Monitor for signs of ischemia.
Ergomar (ergotamine tartrate sublingual tablets) is a first-line abortive therapy for acute migraine attacks, but its use is limited by vasoconstrictive risks. Avoid in patients with coronary artery disease, hypertension, peripheral vascular disease, or pregnancy. Administer at the first sign of migraine; sublingual route offers rapid absorption. Concomitant use with potent CYP3A4 inhibitors (e.g., macrolides, protease inhibitors) is contraindicated due to risk of ergotism. Limit total dose to 6 mg per attack and 10 mg per week.
Take at the first sign of migraine headache for best effect.,Do not take more than 6 tablets per attack or 10 tablets per week.,Avoid use if you are pregnant, breastfeeding, or have high blood pressure, heart disease, or circulation problems.,Seek emergency care if you experience severe stomach pain, chest pain, numbness, tingling, or muscle cramps.,Do not take with other ergotamine drugs or strong CYP3A4 inhibitors (e.g., azole antifungals, macrolide antibiotics).,Store at room temperature, away from heat and moisture.
Take one sublingual tablet at the first sign of migraine, placing it under the tongue to dissolve, and do not swallow.,Do not exceed 3 tablets per attack or 5 tablets per week; overuse can lead to serious side effects.,Seek immediate medical attention if you experience symptoms of ergotism like severe coldness, numbness, or pain in hands/feet, muscle cramps, chest pain, or rapid heartbeat.,Avoid grapefruit and grapefruit juice during treatment as it may increase the risk of side effects.,Inform your doctor if you are pregnant, breastfeeding, or have any history of heart disease, high blood pressure, or peripheral artery disease.
No interactions on record
No interactions on record
Explore head-to-head clinical comparisons of other medications in the same therapeutic classes.
Common clinical questions about CAFERGOT vs ERGOMAR, answered by our medical review team.
CAFERGOT is a Antimigraine Agent (Ergot Alkaloid) that works by Ergotamine is a serotonin (5-HT1B/1D) receptor agonist that causes vasoconstriction of cranial blood vessels and inhibits neurogenic inflammation. Caffeine is a methylxanthine that enhances ergotamine absorption and may contribute to vasoconstriction.. ERGOMAR is a Ergot Alkaloid Antimigraine that works by Ergotamine acts as a partial agonist at serotonin 5-HT1B and 5-HT1D receptors, causing vasoconstriction of cranial blood vessels. It also inhibits norepinephrine reuptake and has alpha-adrenergic blocking activity.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between CAFERGOT and ERGOMAR depend on the specific clinical indication. These are agents from distinct pharmacological classes and are not directly interchangeable by dose. A physician or clinical pharmacist should guide any therapeutic switching decisions.
The standard adult dose of CAFERGOT is: 1 to 2 tablets (each containing ergotamine tartrate 1 mg and caffeine 100 mg) orally at onset of migraine, then 1 tablet every 30 minutes as needed, maximum 6 tablets per attack or 10 tablets per week. Alternatively, 1 rectal suppository (ergotamine tartrate 2 mg and caffeine 100 mg) at onset, repeat once after 1 hour if needed, maximum 2 suppositories per attack or 5 per week.. The standard adult dose of ERGOMAR is: Ergotamine tartrate 1-2 mg sublingually or orally at onset of migraine, then 1-2 mg every 30 minutes as needed, maximum 6 mg per attack and 10 mg per week.. Dosing should always be individualized based on indication, renal and hepatic function, age, and other patient factors.
No direct drug-drug interaction has been formally documented between CAFERGOT and ERGOMAR in current clinical databases. However, individual patient risk factors including other medications, organ function, and comorbidities should always be evaluated by a qualified healthcare provider.
The maternal-fetal safety profiles differ. CAFERGOT is classified as Category C. FDA Category X. First trimester: ergotamine is a potent vasoconstrictor and uterine stimulant, associated with increased risk of spontaneous abortion, congenital anomalies (includi. ERGOMAR is classified as Category C. Ergotamine (ERGOMAR) is contraindicated in pregnancy due to its oxytocic properties and potential for uterine hyperstimulation, fetal hypoxia, and congenital anomalies. First trime. Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.