Drug General Information (ID: DDIL3H0OFQ)
Drug Name			Ergotamine		Drug Info		Isosorbide mononitrate		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Analgesics				Vasodilator Agents
Structure

Mechanism of Ergotamine-Isosorbide mononitrate Interaction (Severity Level: Moderate)
Antagonize the effect of antihypertensive agents Click to Show/Hide Mechanism Graph
Drug Name		Ergotamine				Isosorbide mononitrate
Mechanism		Hypertensive effects				Hypotensive effects Guanylate cyclase  Agonist
Key Mechanism Factor 1
		Factor Name		Guanylate cyclase soluble				Structure Sequence
		Protein Family		Adenylyl cyclase class-4/guanylyl cyclase family
		Protein Function		There are two types of guanylate cyclases: soluble forms and membrane-associated receptor forms. Activated by nitric oxide in the presence of magnesium or manganese ions.     Click to Show/Hide
Mechanism Description		Antagonize the effect of Ergotamine when combined with Isosorbide mononitrate

Recommended Action
Management		This combination should generally be avoided. Ergot alkaloids are considered contraindicated in patients with ischemic heart disease.

References
1	Product Information. D.H.E. 45 (dihydroergotamine). Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
2	Raberger G, Schutz W, Zimpfer M, Kraupp O "The influence of dihydroergotamine on adenosine-induced and reactive coronary vasodilation. Interaction of dihydroergotamine and coronary vasodilation." Basic Res Cardiol 71 (1976): 645-51
3	Bobik A, Jennings G, Skews H, Esler M, McLean A "Low oral bioavailability of dihydroergotamine and first-pass extraction in patients with orthostatic hypotension." Clin Pharmacol Ther 30 (1981): 673-9