Effects of red clover isoflavones on tall fescue seed fermentation and microbial populations in vitro

Negative impacts of endophyte-infected Lolium arundinaceum (Darbyshire) (tall fescue) are responsible for over $2 billion in losses to livestock producers annually. While the influence of endophyte-infected tall fescue has been studied for decades, mitigation methods have not been clearly elucidated. Isoflavones found in Trifolium pratense (red clover) have been the subject of recent research regarding tall fescue toxicosis mitigation. Therefore, the aim of this study was to determine the effect of ergovaline and red clover isoflavones on rumen microbial populations, fiber degradation, and volatile fatty acids (VFA) in an in vitro system. Using a dose of 1.10 mg × L-1, endophyte-infected or endophyte-free tall fescue seed was added to ANKOM fiber bags with or without 2.19 mg of isoflavones in the form of a control, powder, or pulverized tablet, resulting in a 2 × 3 factorial arrangements of treatments. Measurements of pH, VFA, bacterial taxa, as well as the disappearance of neutral detergent fiber (aNDF), acid detergent fiber (ADF), and crude protein (CP) were taken after 48 h of incubation. aNDF disappearance values were significantly altered by seed type (P = 0.003) and isoflavone treatment (P = 0.005), and ADF disappearance values were significantly different in a seed × isoflavone treatment interaction (P ≤ 0.05). A seed × isoflavone treatment interaction was also observed with respect to CP disappearance (P ≤ 0.05). Eighteen bacterial taxa were significantly altered by seed × isoflavone treatment interaction groups (P ≤ 0.05), eight bacterial taxa were increased by isoflavones (P ≤ 0.05), and ten bacterial taxa were altered by seed type (P ≤ 0.05). Due to the beneficial effect of isoflavones on tall fescue seed fiber degradation, these compounds may be viable options for mitigating fescue toxicosis. Further research should be conducted to determine physiological implications as well as microbiological changes in vivo.

[Treatment and prophylaxis of an acute migraine attack]

The treatment of migraine takes into consideration the intensity of the headache and the accompanying symptoms. The goal is to reduce the headache intensity, to relieve nausea and vomiting and to restore the ability to function in the daily routine. For drug treatment, there are now highly effective serotonin agonists available in addition to the older ergotamine preparations. A problem with all migraine analgesics is that in long lasting migraine attacks, the headache can recur as the pharmacological effect of the medication wears off. Through nonmedicinal and medicinal prophylactic measures, the frequency and intensity of the migraine attacks can be reduced. Keeping a headache diary for documentation is essential.

[Headaches caused by abuse of symptomatic anti-migraine and analgesic treatment]

These daily or near-daily headaches result from the chronic overuse of all immediate relief antimigraine drugs: ergotamine, analgesics, and/or more recently triptans. Like for much chronic daily headaches, the International Headache Society diagnostic criteria for drug abuse headaches are difficult to apply. Generally, patients confuse primary headaches (usually migraines) with interparoxysmal tension-type headaches called "rebound headaches". Psychosocial factors may play a role. Insidiously, a compulsive automedication results, often in anticipation of headache. This headache syndrome resists symptomatic and prophylactic treatment. These headaches are frequent, very disabling and socioeconomically costly. They are still largely underdiagnosed. Drug-induced headaches may be restricted to those patients who are already headache sufferers. The pathogenesis is not clearly understood: it may involve a deficience of inhibitory pain modulation, a hyperactivation of nociceptive facilitatory systems, and the peripheral and central effects of the incriminating drugs. The withdrawal of all offending analgesic drugs and a multimodality approach are indispensable, but the therapeutic protocoles are actually very heterogeneous and poorly estimated. Non-drug means could be very helpful. Effective education of headache sufferers and regular follow-up are essential to avoid relapses. Prognosis factors have been evoked, but may not be significant for the long term outcome. The rate successfull of is actually estimated at 60 p. cent at five years. The benefits of an adequate management encourage early recognation of drug-induced headaches. This article has in view to take stock of the literature at the end of 1999, and to help physicians become mora aware of this problem and develp a more preventive attitude.

Toxicokinetics of ergovaline in the horse after an intravenous administration

The toxicokinetics of ergovaline (an ergopeptine mycotoxin present in some grasses infected with endophytic fungus of the genus Neotyphodium) were studied after intravenous administration of a single dose of 15 microg/kg bwt in four gelding horses. Plasma ergovaline concentrations were measured by high performance liquid chromatography, and the kinetic data were described by a three-compartment model. The elimination half-life and the total clearance of ergovaline were found to be 56.83 +/- 13.48 min and 0.020 +/- 0.004 L/min x kg, respectively. According to the toxicological data previously reported in the horse, and in spite of the very low dose administered, clinical signs were observed, including excessive coolness of the ears and the nose, excessive sweating and prostration.

[Profile of the migrainous patients according to drug intakes]

Migraine headache is a common, recurrent and often incapacitating disorder resulting in a substantial loss of work days and productivity, significant consumption of medicines, and considerable economic cost. We performed this study in order to determine the characteristic features of migrainous patients with regular or frequent intake of ergotamine preparations and non steroidal anti-inflammatory drugs (NSAIDs) and the existence of significant differences between both groups. 186 patients were included in the study, 36.6% suffering from migraine without aura and 63.4% from migraine with aura. 24.7% were males and 75.3% females. Mean age of the sample was 35.6 +/- 12.9 years. With regard to medication used for immediate relief of headache, 74.7% patients reported an intake of analgesics and 25.3% ergotamine preparations. In patients with analgesic intake the mean age was significantly lower than in patients with ergotamine for treatment of migraine. When clinic features of these two headache groups were examined, the duration of migraine attacks in the analgesic group was significantly higher (p = 0.0014) than in the ergotamine group, and the severity of migraine was lower (p < 0.05) than in this group. Among associated symptoms, nausea and vomiting were significantly less frequent (p = 0.024) in the analgesic group than in the group of patients with ergotamine intake.

Influence of alkaloid concentration of tall fescue straw on the nutrition, physiology, and subsequent performance of beef steers

Two experiments were conducted to evaluate digestion, performance, and physiological responses to Acremonium coenophialum-infected tall fescue straw offered to vary ergovaline concentrations. In Exp. 1, 16 Hereford x Angus ruminally cannulated steers (370 +/- 12 kg BW, mean +/- SE) were blocked by age and BW and, within block, randomly assigned to one of four treatments containing graded concentrations of ergovaline in the diet: 1) 0 ppb, 2) 158 ppb, 3) 317 ppb, and 4) 475 ppb. Alkaloid concentrations were produced using various mixtures of two varieties of tall fescue straw that had similar genetic and phenotypic characteristics but differed in degree of endophyte incidence and associated concentrations of alkaloids. In the 36-d digestion study, feed intake, apparent DMD, and total tract NDF digestion were not influenced by alkaloid concentration (P > .10). Differences were observed with digesta kinetics; specifically indigestible ADF (IADF) fill and outflow decreased linearly with increasing alkaloid concentration (P < .10). These differences, however, may be attributed to differences in IADF concentration of the diets. Physiological variables (heart rates, respiration rates, and rectal, ear, and tailhead skin surface temperatures) were not influenced by alkaloid concentration (P > .10). Concentration of serum prolactin measured weekly tended (P < .10) to decrease with increasing alkaloid concentration of the diet. At the conclusion of the study, each steer was injected with 100 micrograms of thyrotropin-releasing hormone (TRH). All steers responded to the TRH challenge (P < .10); however, responses did not differ (P > .10) between alkaloid concentrations of the basal diet (P > .10).(ABSTRACT TRUNCATED AT 250 WORDS)

Office management of benign headache. The science and the art

Headache management requires a comprehensive strategy that includes accurate diagnosis, reassurance and education of the patient, nonpharmacologic methods of preventing attacks, and appropriate use of prophylactic and abortive medications. Personal input from the physician and judicious selection of headache medications are crucial. Implementation of such a strategy gives patients greater ability to control and cope with their headaches.

The effects of endophyte-infected tall fescue consumption on diet utilization and thermal regulation in cattle

Two experiments were conducted to determine the effects of endophyte fungus (Acremonium coenophialum) ingestion in tall fescue diets and environmental temperature on heat dissipation and diet utilization by cattle. In Exp. 1, 12 Angus heifers (average weight 244 kg) were allotted by weight to either an endophyte-free (E-) or endophyte-infected (E+; 381 ppb of ergovaline) diet. Environmental temperature varied between 22 and 32 degrees C. Voluntary DM and water intakes were similar (P > .10) among treatments. Rectal temperatures and concentrations of prolactin in plasma were lower (P < .05) after ingestion of the E+ diet. Plasma triiodothyronine, thyroxine, and cortisol concentrations were not affected by diet. In Exp. 2, 24 Holstein steers (average weight 114 kg) were allotted by weight to either E- or E+ (285 ppb of ergovaline) and one of two environmental temperatures (22 or 32 degrees C). At 32 degrees C, feed intake was reduced by 22%, and water consumption was increased by 62% compared with steers housed at 22 degrees C. Consumption of E+ reduced feed intake by 10% but did not influence water consumption. Plasma concentration of prolactin was decreased (P < .05) within 48 h after consumption of E+. Rectal temperatures increased in response to both environmental temperature (P < .05) and E+ consumption (P = .06). Digestibilities of DM and OM for E+ were 9% lower (P < .05) than for E-.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of endophyte-infected tall fescue consumption and use of a dopamine antagonist on intake, digestibility, body temperature, and blood constituents in sheep

Two experiments were conducted with lambs that consumed endophyte-infected (Acremonium coenophialum) tall fescue diets under elevated temperature and humidity and supplemented with the dopamine antagonist metoclopramide (M). In Exp. 1, 12 ruminally cannulated wethers (average weight 49 kg) were allotted by weight to either an endophyte-free diet (E-) or endophyte-infected diet (E+; 1,170 ppb of ergovaline), or E+ supplemented with M (15 mg/kg of lamb BW; E+M). Ad libitum DM intake and digestibility were lower (P < .05) for E+ than for E- diet. Supplementation of E+ with M increased (P < .05) DM intake by 27.6% but did not change DM digestibility. Body temperature increased (P < .05) when lambs consumed E+ and was further increased when M was supplemented. For Exp. 2, 19 wether lambs (average weight 24 kg) were allotted to treatments to evaluate the effects of endophyte consumption (0 vs 2,430 ppb of ergovaline) and supplementation with M (0 vs 20 mg/kg BW). An interaction (P < .05) of main effects was measured for DM intake. Lambs that consumed E+M consumed more DM than did lambs fed only E+, but lambs offered the E- diet and supplemented with M did not increase DM consumption. Diet DM digestibility was not different among treatments. Skin vaporization decreased (P < .05) due to E+ consumption and M supplementation. The concentration of prolactin in plasma was decreased (P < .05) by consumption of E+ (8 vs 136 ng/mL) and did not increase due to M supplementation.(ABSTRACT TRUNCATED AT 250 WORDS)

Performance, forage utilization, and ergovaline consumption by beef cows grazing endophyte fungus-infected tall fescue, endophyte fungus-free tall fescue, or orchardgrass pastures

Two 120-d trials (May to September, 1988 and 1989) determined the effects of grazing tall fescue (two varieties) or orchardgrass on forage intake and performance by beef cows. Each summer, 48 cow-calf pairs grazed endophyte-infected Kentucky-31 tall fescue (KY-31), endophyte-free Mozark tall fescue (MOZARK), or Hallmark orchardgrass (OG) pastures (16 pairs/treatment). Forage OM intakes and digestibilities were determined during June and August each year. Cow and calf BW and milk production were determined every 28 d. During June of both years, OM intakes did not differ (P greater than .10) among treatments. During August of 1988, intakes were 18% lower (P less than .05) by KY-31 cows (1.6% of BW) than by MOZARK or OG cows (average 1.95% of BW); however, no differences (P greater than .10) were measured in August of 1989. Estimates of ergovaline consumption during June from KY-31 were between 4.2 (1988) and 6.0 mg/d (1989), whereas August estimates were between 1.1 (1988) and 2.8 mg/d (1989). Ergovaline in MOZARK estrusa was below detection limits, except in August of 1989. Cows that grazed KY-31 lost three times (P less than .01) more BW than cows that grazed MOZARK or OG (42 vs 9 and 13 kg, respectively). Milk production by KY-31 cows was 25% lower (P less than .01) than that by cows that grazed MOZARK or OG (6.0 vs average of 8.0 kg/d). Similarly, slower (P less than .01) calf gains were noted for KY-31 than for MOZARK or OG (.72 vs .89 and .88 kg/d, respectively). Cows grazing KY-31 experienced accelerated BW loss and reduced milk production and weaned lighter calves than did cows grazing MOZARK or OG. Decreased performance was not explained by consistently reduced forage intakes; hence, altered nutrient utilization was suspected.

[Non-tropical sprue and chronic inflammatory rectal stenosis in a patient with abuse of ergotamine-containing suppositories]

A 51 year old Yugoslavian patient was admitted to our hospital in reduced general condition with distinct hypocalcemia, osteomalacia, and with rectum stenosis. Our investigations led to the diagnosis of a malabsorption syndrome due to non-tropical sprue. The most likely cause of the rectum stenosis is an abuse of ergotamine-containing suppositories for several years. A gluten-free diet and the interruption of the use of the suppositories improved her general condition remarkably.

Daily chronic headache

Headache is a disabling condition, and medical science has not, until recently, begun to address it in a fashion consistent with its widespread impact. Despite the limitations in our current understanding, as well as the historical prejudice directed toward patients with this condition, current understanding and treatment approaches can provide hope and relief for most patients who have these disorders.

Ergotamine-induced solitary rectal ulcer

A rare case of ergotamine-induced solitary rectal ulcer is described in a 41 year old woman who used high doses of ergotamine tartrate-containing suppositories for severe migraine headaches. Complete recovery of the ulcer was noticed after cessation of treatment with the suppositories. The relevant literature is discussed.

Species dependent dual modulation of the benzodiazepine/GABA receptor chloride channel by dihydroergosine

Dihydroergosine (50 and 100 mg/kg) enhanced the incidence of bicuculline (3 mg/kg)-induced convulsions in female rats, while 100 mg/kg of dihydroergosine given to female mice made 45% convulsive dose of bicuculline (2.5 mg/kg) to be subconvulsive. The same dose of dihydroergosine enhanced in mice the latency of bicuculline (4 mg/kg)-induced convulsions. Although, in in vitro experiments dihydroergosine showed very weak ability to prevent the binding of 3H-muscimol, the drug was able to diminish and to augment the IC50 of bicuculline and GABA when added to crude synaptosomal pellet of the rat and mouse brain respectively. Lower concentrations of dihydroergosine stimulated and higher inhibited 3H-TBOB binding to the crude synaptosomal pellet of the rat brain. In the preparation of mouse brain dihydroergosine produced only inhibition of 3H-TBOB binding. Only slight quantitative differences were observed in bicuculline-induced stimulation and in GABA- and diazepam-induced inhibition of 3H-TBOB binding between the two species. The results suggest that the opposite species-dependent effects of dihydroergosine on bicuculline-induced convulsions are due to the ability of this drug to modulate species-dependently the benzodiazepine/GABA receptor chloride channel complex.

Pressor effect of inhaled ergotamine in orthostatic hypotension

Treatment of orthostatic hypotension due to autonomic failure frequently necessitates use of pressor agents. Because venous pooling contributes significantly to this disorder, the venoconstrictive properties of ergotamine offer theoretical advantages over pure arteriolar pressor agents. However, the low and erratic bioavailability of oral preparations has hindered the use of ergotamine. Accordingly, the efficacy of inhaled ergotamine tartrate (1 puff, 0.36 mg) was compared to placebo in 8 patients with severe autonomic failure. Blood pressure was monitored in the seated position with an automated device. Ergotamine produced significant increases in systolic (29 +/- 5 mm Hg, p less than 0.01 by analysis of variance) and diastolic (13 +/- 1 mm Hg, p less than 0.001) blood pressures compared to placebo (-9 +/- 5 and -2 +/- 3, respectively). Upright blood pressure 2 hours after administration was significantly greater with ergotamine (119 +/- 8/69 +/- 6 mm Hg) vs placebo (82 +/- 7/59 +/- 5 mm Hg, p less than 0.05). Motionless standing time, a measurement of functional capacity, also improved with ergotamine (200 +/- 58 vs 85 +/- 22 seconds). No side effects were noted, but patients with coronary or peripheral artery disease were excluded. Inhaled ergotamine may provide an effective and practical therapy for disabling orthostatic hypotension due to autonomic failure.

Gastrointestinal vascular ischemia caused by ergotamine

In the investigation of abdominal pain due to ergotism, arteriography will show vascular abnormalities similar to those observed peripherally in this disorder. Ergotism is rare, and failure to diagnose it will result in ineffectual therapy. In the majority of situations, ergotism can usually be successfully treated by withdrawal alone. In situations of threatened limb or organ loss, sodium nitroprusside appears to rapidly reverse the vasospasm due to ergotism and is likely the therapy of choice.

Enhancing the effectiveness of abortive therapy: a controlled evaluation of self-management training

Research suggests that approximately one half of recurrent headache sufferers fail to adhere properly to drug treatment regimens with as many as two thirds of patients failing to make optimal use of abortive medications such as ergotamine. In spite of these findings there are no controlled studies that have attempted to evaluate methods for improving adherence to drug regimens for the treatment of chronic headache disorders. In an initial effort to address this adherence problem thirty-four recurrent migraine sufferers were randomized to abortive therapy with ergotamine tartrate plus caffeine (standard abortive therapy) or to standard abortive therapy accompanied by a brief educational intervention designed to facilitate the migraine sufferer's effective use of ergotamine. Patients who received the adjunctive educational intervention attempted to abort a greater percentage of their migraine attacks (70% vs 40%) and showed larger reduction in headache activity (e.g., 40% vs 26% reduction in month two of treatment). However, patients in both treatment groups used similar amounts of abortive medication when attempting to abort a migraine attack and showed similar reductions in analgesic medication use with abortive therapy. There results suggest that brief educational interventions designed to address the problem of patient adherence may yield significant improvements in standard therapies. We argue that such educational interventions deserve more attention in the headache treatment literature than they have received to date.

[Proctomucosectomy and colo-anal anastomosis in rectovaginal fistula following the use of suppositories containing ergotamine]

We observed a rectovaginal fistula in 2 patients who had applied ergotamine suppositories against migraine headaches. The local effect of ergotamine on the rectum mucosa as well as the higher systemic concentration after rectal application seem to promote the development of a rectovaginal fistula. Different methods for the surgical fistula repair are discussed, depending on location and diameter of the fistula. In our patients we have carried out the abdomino-transanal resection of the rectum with sutured colo-anal anastomosis.

Bioavailability of dihydroergosine in healthy volunteers

Eight healthy volunteers received an oral dose of 10 mg and an intravenous dose of 0.75 mg of dihydroergosine. Plasma concentrations were measured by HPLC method, and some pharmacokinetic parameters were calculated. The biologic half-life in the elimination phase was 8.35 +/- 1.87 h after oral administration and 8.84 +/- 3.64 h after intravenous administration. In both cases of administration a secondary rise in plasma concentration of dihydroergosine was observed, which can be attributed to hepatic recycling. The calculated bioavailability of the drug was 9.80 +/- 2.8%.

Comparison of pharmacodynamic effects and plasma levels of oral and rectal ergotamine

Plasma levels and the vasoconstrictive effect of 1 mg ergotamine tartrate given as tablets or suppositories were compared. In a crossover study, eight male volunteers received tablets or suppositories containing ergotamine in a drug combination (Anervan) and, as a control, suppositories without ergotamine. Blood sampling and measurement of toe-arm systolic gradients with a strain-gauge technique were done for up to 6 h and again after 24 h and 48 h. Only 29 of 160 blood samples contained detectable (greater than 0.1 ng/ml) amounts of ergotamine, and kinetic comparison could not be performed. Only ergotamine-containing suppositories caused a significant (p less than 0.008) decrease in toe-arm systolic gradient which was significantly different (p less than 0.003) from the effects of ergotamine tablets and control suppositories. Rectal ergotamine is thus more biologically active, for the factor used, than oral ergotamine. We suggest that a rectal dose of 1 mg ergotamine tartrate should be tried as the initial dose in the treatment of migraine attacks.

Intramuscular ergotamine: plasma levels and dynamic activity

Ergotamine tartrate (0.5 mg) was injected intramuscularly into 10 subjects with migraine. The effect on peripheral arteries, measured as a decrease in toe-arm systolic gradients, developed slowly and was well sustained after 29 hr. In contrast, ergotamine was quickly absorbed (t1/2 = 3 min) and plasma levels (measured by HPLC) declined, with a biologic t1/2 of 2.5 hr. A hypothetic effect compartment model was adopted and kinetic and dynamic data were simultaneously fitted on a computer. Calculated from mean data, the rate constant for equilibration of the drug between plasma and effector site was 0.07 hr-1, with a t1/2 of 9.9 hr, and the steady-state plasma concentration resulting in 50% of maximal effect (Cpss50) was 0.24 ng/ml. The largest variability for the estimated kinetic and dynamic parameters among subjects was found for Cpss50 (coefficient of variation = 110%), indicating that, in addition to some kinetic variability, dynamic variability (difference in sensitivity) should be anticipated in the therapeutic use of ergotamine.

Cluster headache with trigeminal neuralgia. An uncommon association that may be more than coincidental

Cluster headache and trigeminal neuralgia (tic douloureux) share a common pattern of exacerbation and remission of pain that is described in similar terms by patients. Although the treatment of these conditions is markedly different, the results of adequate prophylaxis can be extremely impressive in both. The physician who treats headache patients should be aware of the common characteristics of each condition and of the possibility of their concomitant occurrence.

Ergotaminism after a single dose of ergotamine tartrate

A 32-year-old female developed classical signs and symptoms of ergotaminism after taking a single rectal suppository of ergotamine tartrate. Her symptoms gradually resolved with minimal therapy over the next week. Ergotaminism is the most frequent form of ergotism and should be considered in all patients with vascular insufficiency who are taking ergotamine-containing drugs.

Low bioavailability of ergotamine tartrate after oral and rectal administration in migraine sufferers

Fifteen migraine patients were administered 2 mg ergotamine tartrate in a partial cross-over design as a single, oral tablet, rectal suppository and rectal solution. Eight of these patients were in a previous investigation given 0.5 mg ergotamine tartrate intravenously. The blood samples were taken up to 54 h after oral and suppository while it was followed for only 3 h after rectal solution. The chemical analysis was performed by applying h.p.l.c. method with a limit of sensitivity of 0.1 ng/ml ergotamine base in plasma. No ergotamine was detected in the blood samples after the oral route, whereas small and very variable quantities was found in blood after the rectal route. Regular calculation of bioavailability could therefore not be performed. An estimate of the maximal possible bioavailability was found to yield a mean value of 2% (tablets); 5% (suppositories) and 6% (rectal solution). Rectal solution elicited faster absorption and the extent of absorption was significantly higher (P less than 0.05) than for the suppository.

[Doppler ultrasound studies of the extracranial cerebral vessels in migraine patients after ergotamine tartrate administration]

Doppler ultrasound investigations were done in 20 patients with migraine during the symptom-free interval after oral administration of 2 mg and 6 mg ergotamine tartrate. The observed changes of end-diastolic flow velocity as a measure of peripheral total resistance permit simultaneous assessment of the vasoconstrictor effect of ergotamine in the perfusion area of the internal and external carotid arteries. A dosage of 2 mg led to an exclusive increase of resistance in the external carotid artery area without significant changes in the internal carotid area. A maximal therapeutic dosage of 6 mg ergotamine tartrate did not lead to a significant increase of the vasoconstrictor effect in the external carotid circulation. In addition, a barely registrable increase of resistance in the internal carotid area could now be observed.

Optimal routes of administration of ergotamine tartrate in cluster headache patients. A pharmacokinetic study

Bioavailability and rate of absorption of ergotamine were studied in eight cluster headache patients outside attacks. In a cross-over design, approximately 2 mg ergotamine tartrate was administered as effervescent tablets, suppositories, and from an inhalation device, with 0.25 mg intravenously as the reference. Ergotamine in plasma was measured by high performance liquid chromatography with fluorescence detection from 5 to 420 min. For all three routes of administration, a similar low (0.5-4.2%) bioavailability of ergotamine was estimated. Only inhalation of ergotamine resulted in early (at 5 min) peak concentrations of ergotamine in plasma and is therefore most likely to relieve the short-lived attacks of cluster headache. The inhalation route for ergotamine poses problems, however, and we suggest ways of improving the inhalation device.

Pharmacokinetics of dihydroergosine in rats after intravenous and oral administration

Wistar rats received an intravenous dose of 20 micrograms/kg and an oral does of 40 micrograms/kg 3H-Dihydroergosine. Concentrations of radioactivity were measured in plasma, bile, urine, and faeces, and pharmacokinetical parameters of an open two compartment model were calculated. After intravenous injection and oral administration 3H-Dihydroergosine is rapidly lost from the central compartment with distribution rate constants alpha = 0.889 h-1 and beta = 0.722 h-1, respectively. Biological half life in the elimination phase after both application is nearly the same t 1/2 = 13.6 h. The volume of central compartment is Vc = 3.075 l/kg and the volume of distribution Vd beta = 30.75 l/kg. The fraction of 3H-Dihydroergosine absorbed after oral administration, calculated from areas under the curves upon oral and intravenous administration, is 31%. The percentage of 3H-radioactivity eliminated with bile was 98.3% of the dose within 72 hours after intravenous and 29.3% after oral administration. The main portion of the administered 3H-radioactivity was recovered in faeces -66.1% after intravenous and 81.3% after oral administration, while only 17.4% and 4.9% of the administered dose was eliminated in the urine within 120 hours, respectively.

Lower extremity ischemia due to combined drug therapy for migraine

Three days after initiation of migraine headache therapy with ergotamine tartrate and propranolol, severe acute arterial insufficiency of the lower extremities developed in a 48-year-old woman who had been in general good health. Angiography revealed hypoplastic aortoiliac arteries, with tubular narrowing of the leg arteries. Lower extremity blood pressures rapidly returned to normal with a single intraarterial injection of 25 mg of tolazoline. Cases of peripheral ischemia due to either ergotamine or propranolol have been reported. Combined use of these two drugs may enhance the risk of acute arterial compromise.

Low biological availability of ergotamine tartrate after oral dosing in cluster headache

An attempt was made to determine the plasma ergotamine concentrations in nine male patients with cluster headache 15-600 min after oral therapeutic doses of ergotamine tartrate (Cafergot). Some of the patients were studied twice. Five patients received a constant dose of 2-4 mg daily for at least seven days. Four patients were given 1 mg five times on one day and three patients a single oral dose of 2 mg. Ergotamine was determined by means of high performance liquid chromatography with fluorescence detection--a new highly sensitive, specific method, the detection limit of which is less than 100 pg/ml for ergotamine. Ergotamine tartrate was not discovered in any of the plasma samples. In one patient ergotamine could not be detected in the cerebrospinal fluid one hour after a single oral dose of 2 mg. The oral biological availability is less than 1%, which is the maximal available fraction of unchanged ergotamine after oral administration. A clinical benefit was observed in several of our patients. These effects of the drug may be because of active metabolites being formed and/or to high affinity of ergotamine to cranial vessels.

[Ano-cutaneous gangrenous ergotism]

A case of ergotism by abuse of ergotamine tartrate suppositories is reported. The patient developed the clinical picture of ergotism with multiple perianal ulcers. After ergot had been withdrawn there was a spontaneous healing of these ulcers after a few weeks. It is well known that ergot abuse can develop severe vascular spasm in the arteries, but it is unknown that cutaneous ulcers may occur by topical application.

Systemic availability of ergotamine tartrate after oral, rectal and intramuscular administration

Plasma ergotamine levels were measured in 33 volunteers (subgroups 11, 12 and 10) after a single dose of ergotamine administered by various routes. Ergotamine tartrate was given in doses normally used in the treatment of acute migraine--2.0 mg orally, 2.0 mg combined with 100 mg caffeine rectally and 0.5 mg i.m. Plasma ergotamine concentrations were determined by radioimmunoassay. The highest and longest lasting levels were found after i.m. administration, the peak concentration being 1.94 +/- 0.34 (SEM) ng/ml at 1/2 h. The corresponding maximum concentrations after oral and rectal administration were 0.36 +/- 0.08 ng/ml at 2 h and 0.42 +/- 0.09 ng/ml at 1 h. In most of the subjects the plasma ergotamine level began to rise again at 24 to 48 h. The cause of the elevation is not known but it might favour possible accumulation of the drug. Absorption from suppositories was at least as good as after oral administration and the former route may therefore be advantageous for migraine patients in whom nausea and vomiting during an attack may prevent efficient oral medication.

Prolactin-lowering effect of low doses of lisuride in man

Lisuride, a new semisynthetic ergot derivative, effectively decreased the TRH-induced hyperprolactinaemia in healthy female volunteers at a dose of 300 microgram given orally. Basal prolactin levels were suppressed after a single dose of 100 and 200 microgram lisuride. This effect was still present 6 h after administration. Two hundred microgram lisuride also decreased the high serum prolactin levels produced by im injection of 50 mg sulpiride, and conversely, sulpiride injection abolished the prolactin lowering effect of lisuride. These results demonstrate that in man too lisuride is a very potent prolactin-lowering agent. In addition, the data support the hypothesis of a predominant role of dopaminergic mechanisms in the regulation of prolactin secretion.