ERGOLOID MESYLATE

ERGOLOID MESYLATE
(er'goe-loid mess'i-late)
Gerimal, Hydergine
Classifications: alpha-adrenergic antagonist; ergot alkaloid;
Therapeutic: antidementia

Prototype: Ergotamine tartrate
Pregnancy Category: X

Availability

0.5 mg, 1 mg sublingual tablets; 1 mg tablets; 1 mg/mL oral liquid

Action

Produces peripheral vasodilation primarily by central action and may cause slight reduction in BP and heart rate. Relieves symptoms of cerebral arteriosclerosis.

Therapeutic Effect

Some improvements in Alzheimer's dementia symptoms, possibly by increasing cerebral metabolism with consequent increase in blood flow. Improvement may not be apparent until after 3–4 wk of therapy.

Uses

Senile dementia of Alzheimer type.

Contraindications

Acute or chronic psychosis; hypersensitivity to ergoloid; pregnancy (category X), lactation.

Cautious Use

Acute intermittent porphyria; elderly; hepatic disease; hypotension; bradycardia.

Route & Dosage

Senile Dementia of Alzheimer Type
Adult: PO 1 mg t.i.d.; doses up to 4.5–12 mg/d have been used

Administration

Sublingual
  • Instruct patient to allow sublingual (SL) tablet to dissolve under tongue and not to drink, eat, or smoke while tablet is in place. Do not crush SL tablets.
  • Store in tightly closed container.

Adverse Effects (≥1%)

Body as a Whole: Mostly dose related. CV: Orthostatic hypotension, dizziness or light-headedness, flushing, sinus bradycardia. Special Senses: Blurred vision, nasal stuffiness, increased nasopharyngeal secretions. GI: Sublingual irritation, anorexia, stomach cramps, transient nausea and vomiting, heartburn. Skin: Skin rash. CNS: Drowsiness, headache. Other: Precipitation of acute intermittent porphyria.

Interactions

Drug: No clinically significant interactions established.

Pharmacokinetics

Absorption: Incompletely from GI tract; 50% reaches systemic circulation. Peak: 1.5–3 h. Metabolism: Undergoes rapid first-pass metabolism in liver. Elimination: Primarily in feces. Half-Life: 2–12 h.

Nursing Implications

Assessment & Drug Effects

  • Establish baseline values of BP and pulse; check at regular intervals throughout therapy.
  • Report to physician sinus bradycardia (40 bpm); has been reported in patients receiving 1.5 mg doses. Pulse rate usually returns to normal within 2 d after drug is discontinued.
  • Withdraw drug permanently if marked bradycardia or hypotension occurs.

Patient & Family Education

  • Make position changes slowly, particularly from recumbent to upright posture, and move ankles and feet for a few minutes before walking.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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