Erythromycin-associated ergotamine intoxication: arteriographic and electrophysiologic analysis of a rare cause of severe ischemia of the lower extremities and associated ischemic neuropathy.
Vasospasm associated with ergotamine is a well-known phenomenon. In this case report we present a rare drug interaction between erythromycin and ergotamine at normal doses causing lower extremity ischemia in a 36-year-old woman. Nitroprusside proved to be the treatment of choice. The response was dramatic and took place in a matter of hours in this patient. Ischemic monomelic neuropathy is a recently described entity in which axonal necrosis is caused by a loss of distal extremity blood flow. The association between erythromycin and ergotamine may be a dangerous pharmacologic combination; drugs that have a hepatic cycle with ergotamine derivatives must be used with caution.
Ghali
R
R
Department of Surgery, St. Sacrement Hospital, Laval University, Quebec, Canada.
De Léan
J
J
Douville
Y
Y
Noël
H P
HP
Labbé
R
R
D000328:Adult; D000792:Angiography; D004347:Drug Interactions; D004878:Ergotamine / Q000506:poisoning*; D004917:Erythromycin / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000139:chemically induced* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy; D007866:Leg / Q000098:blood supply* / Q000294:innervation; D009431:Neural Conduction; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000175:diagnosis
D004917:Erythromycin; D004878:Ergotamine