A woman who had previously taken ergotamine tartrate successfully and uneventfully for 16 years was given doxycycline and dihydroergotamine 30 drops three times a day. Five days later her hands and feet became cold and reddened,and she was diagnosed as having a mild form of ergotism.(See reference number 1)
Other cases of ergotism,some of them more severe, have been described in two patients taking ergotamine tartrate and doxycycline,(See reference number 2,3) and in 3 patients taking tetracycline-containing preparations (See reference number 2,4,5).
Unknown. One suggestion is that these antibacterials may inhibit activity of liver enzymes concerned with metabolism and clearance of ergotamine, thereby prolonging its stay in body and enhancing its activity (See reference number 1). One of patients had a history of alcoholism(See reference number 2) and two of them were in their eighties,(See reference number 5) so impaired liver function may have played a part.
Information is very limited indeed. The incidence and general importance of this interaction is uncertain, but it would clearly be prudent to be on alert for signs of ergotism in any patient given ergot derivatives and a tetracycline. However, note that one of manufacturers of ergotamine(See reference number 6) actually recommends that concurrent use of tetracycline should be avoided. Impairment of liver function may possibly be a contributory factor in this interaction.
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