Ergotamine-induced peripheral ischaemia reversed by oral thymoxamine hydrochloride

Although there is no generally accepted therapy for ergotamine-induced vasoconstriction, infusion of directly acting vasodilators is regarded presently as the treatment of choice. We present a case of peripheral arterial ischaemia secondary to excessive use of ergotamine suppositories, which was reversed with oral thymoxamine hydrochloride (an alpha 1-adrenoceptor antagonist) and ergotamine withdrawal. We suggest that in patients with ergotamine-induced peripheral arterial vasoconstriction with no evidence of gangrene, oral thymoxamine may be considered as a useful adjunct or possible alternative to infused vasodilator treatment.