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Some medications may increase the risk of dangerously decreased blood flow to the brain, heart, or extremities when taken with caffeine and ergotamine. In rare but severe cases, gangrene or other serious problems can result. The following drugs should not be taken with caffeine and ergotamine or should be used only under the close supervision of a doctor:

• another medication that contains an ergot compound such as Ergomar, D.H.E., or D.H.E. Nasal;

• another migraine headache medicine such as almotriptan (Axert), sumatriptan (Imitrex), zolmitriptan (Zomig), rizatriptan (Maxalt), or naratriptan (Amerge)--these medicines must not be taken within 24 hours of a dose of caffeine and ergotamine;

• a selective serotonin reuptake inhibitor (SSRI) such as citalopram (Celexa), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), sertraline (Zoloft), or paroxetine (Paxil);

• a beta-blocker (which are used to treat high blood pressure, irregular heartbeats, and other heart conditions) such as carteolol (Cartrol), carvedilol (Coreg), labetalol (Normodyne, Trandate), nadolol (Corgard), pindolol (Visken), propranolol (Inderal), sotalol (Betapace), or timolol (Blocadren);

• an HIV/AIDS medicine such as amprenavir (Agenerase), delavirdine (Rescriptor), indinavir (Crixivan), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Norvir), or saquinavir (Invirase, Fortovase);

• the antibiotics erythromycin (Ery-Tab, E.E.S., E-Mycin, Eryc, others) or clarithromycin (Biaxin);

• the antifungals medicines itraconazole (Sporanox) or ketoconazole (Nizoral);

• nefazodone (Serzone);

• cimetidine (Tagamet, Tagamet HB); or

• sibutramine (Meridia).

The use of caffeine and ergotamine may be dangerous if you are taking any of the drugs listed above.

Drugs other than those listed here may also interact with caffeine and ergotamine. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.

Stop taking caffeine and ergotamine and seek emergency medical attention or contact your doctor immediately if you experience.

• an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);

• chest pain;

• numbness or tingling in the fingers or toes;

• muscle pain in the arms or legs;

• leg weakness;

• changes in heart rate;

• swelling; or

• itching.

Other, less serious side effects may also occur. Continue to take caffeine and ergotamine and talk to your doctor if you experience nausea or vomiting.

Caffeine and ergotamine may be habit forming when used for long periods of time. Larger doses may be needed for headache relief, and withdrawal effects may occur when caffeine and ergotamine therapy is stopped.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.