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Ergot alkaloid and alpha adrenergic receptor antagonist with vasoconstrictor effect.
Indicated in the treatment of acute migraine attack, usually together with caffeine.
Oral administration every half hour if necessary, up to a maximum of 6 mg per day (Sandoz 2012, AEMPS 2009).
Since the last update we have not found published data on its excretion in breastmilk.
Its pharmacokinetic data (high molecular weight and high plasma protein binding) makes it unlikely it will transfer into breastmilk in significant amounts.
Although gastrointestinal absorption is 62%, hepatic metabolism makes bioavailability less than 5% (AEMPS 2009), which impedes its transfer from breastmilk to infant plasma, except in premature infants and the immediate neonatal period when there may be greater intestinal permeability.
Other ergot alkaloids, such as bromocriptine, inhibit prolactin secretion, but administration of 3mg daily of ergotamine during the first week postpartum did not affect the production of breastmilk or the weight gain of infants, who did not present problems (Jolivet 1978).
Occasional use and at a sufficient minimum dose would not create problems during breastfeeding.
Until there is more published data on this drug in relation to breastfeeding, safer known alternatives are preferable (Bordini 2016, Davanzo 2014, Duong 2010, Jürgens 2009, Loder 2007, MacGregor 2007, Moretti 2000), especially during the neonatal period and in cases of prematurity.
Sumatriptan, which is known to have minimal transfer to milk (Wojnar 1996), is a good alternative as a treatment for migraine during breastfeeding, and it is also more effective than the ergotamine/caffeine combination (Worthington 2013).