Ergomar Side Effects: What to Expect and When to Call Your Doctor

Ergomar (ergotamine tartrate 2 mg sublingual tablets) is an effective migraine abortive, but it comes with a side effect profile that patients need to understand before taking it. Some effects—like mild nausea—are common and usually manageable. Others are rare but potentially life-threatening and require immediate emergency care.

This guide explains what to expect from Ergomar, how to minimize discomfort, and exactly when you need to stop taking it and call your doctor or 911.

Common Side Effects of Ergomar

These side effects are frequently reported and often improve over time as your body adjusts. Tell your provider if they persist or worsen:

Nausea and vomiting. Ergomar stimulates the chemoreceptor trigger zone in the brain, which frequently causes nausea. This is the most commonly reported side effect. Taking Ergomar at the very first sign of a migraine—before nausea from the migraine itself sets in—may reduce this effect.

Dizziness and weakness. Ergotamine can cause dizziness, lightheadedness, and general weakness. Avoid driving or operating heavy machinery until you know how the medication affects you.

Numbness or tingling in the fingers, toes, or face. Mild tingling in the extremities can occur because of Ergomar's vasoconstrictive properties. Mild, transient tingling may be expected—but persistent, intensifying, or one-sided symptoms need medical attention (see serious side effects below).

Temporary heart rate changes. Ergotamine can cause transient bradycardia (slow heart rate) or tachycardia (fast heart rate) in some patients. These usually resolve without intervention.

Increased blood pressure. Vasoconstriction can cause a temporary increase in blood pressure. Patients with pre-existing hypertension should monitor their blood pressure and notify their provider.

Serious Side Effects: Stop Taking Ergomar and Get Help Immediately

The following are signs of potentially life-threatening complications. If you experience any of these, stop taking Ergomar and call 911 or go to the nearest emergency room immediately:

Signs of peripheral ischemia (poor blood flow to hands and feet): Pale, cold, or bluish fingers or toes; burning pain or cramps in the arms or legs; numbness that intensifies; absence of pulses in hands or feet; color changes in the skin (blue, white, red cycling). This is ergotism—a serious and rare but well-documented complication that can lead to gangrene if untreated.

Signs of a heart attack: Chest pain or tightness; pain radiating to the shoulder, arm, neck, or jaw; shortness of breath; cold sweats; nausea with chest discomfort; feeling faint.

Signs of a stroke: Sudden facial drooping or numbness; sudden weakness or paralysis in an arm or leg; slurred or sudden difficulty speaking; sudden vision loss; sudden severe headache unlike any you've had before; loss of coordination or balance.

Severe allergic reaction: Hives; swelling of the face, lips, tongue, or throat; difficulty breathing; rapid heartbeat with feeling of doom.

The Boxed Warning: CYP3A4 Inhibitors and Peripheral Ischemia

Ergomar carries a boxed warning—the FDA's most serious warning—regarding the risk of life-threatening peripheral ischemia when Ergomar is taken alongside potent CYP3A4 inhibitors. These drugs block the liver enzyme that metabolizes ergotamine, causing blood levels of the drug to rise to toxic concentrations.

Drugs that are absolutely contraindicated with Ergomar include:

Macrolide antibiotics: clarithromycin (Biaxin), erythromycin, troleandomycin

HIV protease inhibitors: ritonavir (Norvir), nelfinavir, indinavir, cobicistat-containing regimens

Azole antifungals: ketoconazole, itraconazole

If you are prescribed any of these medications while taking Ergomar, contact your prescriber and pharmacist immediately before combining them.

Rebound Headaches and Medication Overuse

If you use Ergomar (or any abortive migraine medication) on 10 or more days per month, the medication itself can begin causing more frequent headaches—a condition called medication overuse headache (MOH), also known as rebound headache. Signs include:

Headaches becoming more frequent or daily

Ergomar working less well than it used to

Headaches appearing earlier after each dose

If you think you have MOH, talk to your prescriber. Do not stop Ergomar abruptly if you've been using it frequently—withdrawal can trigger severe rebound headaches and needs to be managed medically.

Tips to Minimize Common Side Effects

Take it early. Ergomar works best—and causes fewer side effects—when taken at the very first sign of a migraine, before full-blown nausea sets in.

Avoid grapefruit. Grapefruit and grapefruit juice can inhibit CYP3A4, raising ergotamine levels and increasing side effect risk.

Don't exceed the dose. Maximum 2 tablets per attack; maximum 5 tablets (10 mg) per week. Most serious complications occur with overdose or in patients who exceed dosing guidelines.

Don't smoke. Nicotine potentiates ergotamine's vasoconstrictive effects, increasing the risk of serious ischemic complications.

The Bottom Line

For most patients who use Ergomar as directed, nausea and mild tingling are the most common experiences—both manageable and usually temporary. The rare but serious complications (ischemia, stroke, heart attack) are most likely when dosing guidelines are exceeded or when Ergomar is combined with contraindicated drugs. For a full list of drug interactions to watch out for, see: Ergomar Drug Interactions: What to Avoid and What to Tell Your Doctor. And if you need help finding your prescription, visit medfinder to locate pharmacies near you with Ergomar in stock.