Abametapir and Ergotamine: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jun 30, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Abametapir
No brand names on recordErgotamine
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Abametapir is a lotion used to treat head lice. Even though you put it on your scalp, some of it gets into your body and can briefly slow down a liver enzyme (called CYP3A4) that helps break down many other medicines.
Ergotamine (Ergomar) is a migraine medicine that your body clears using that same enzyme. If the enzyme is slowed, ergotamine can build up higher than normal. Too much ergotamine can cause serious problems like poor blood flow to the hands and feet. The good news is this is easy to plan around, and your pharmacist or doctor can help you time or adjust things safely.
Mechanism: Abametapir inhibits CYP3A4. Ergotamine is a CYP3A4 substrate, so co-exposure is expected to reduce ergotamine metabolism and increase its systemic exposure (AUC/Cmax).
Direction/effect: Increased ergotamine levels, raising the risk of ergotism (vasospasm, peripheral ischemia).
- Onset: rapid
- Evidence: theoretical (based on abametapir's known CYP3A4 inhibition)
- Severity: major
Management: Avoid CYP3A4 substrates, including ergotamine, for 2 weeks after abametapir application. If ergotamine cannot be avoided, avoid using abametapir. Monitor for signs of ergotism if exposure occurs.
What happens
Increased exposure of CYP3A4 substrate
Interaction Deep Dive
For a period of 2 weeks following abametapir application, refrain from using CYP3A4 substrates. Should avoiding these substrates not be practical, then abametapir itself should not be used 1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism by abametapir
How to manage this interaction
Both drugs can be managed safely with a little planning. The key point is timing.
- Do not start with fear: keep taking medicines as prescribed and talk with your care team before making changes.
- Tell your pharmacist or doctor that you use ergotamine (Ergomar) before an abametapir lice treatment is applied.
- Your team will usually avoid ergotamine for about 2 weeks after abametapir is applied, since the enzyme effect can last that long.
- If ergotamine cannot be paused, your team may choose to avoid abametapir and use a different lice treatment instead.
Report any cold, numb, or painful hands or feet right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Abametapir and Ergotamine together?
Abametapir can raise ergotamine levels by blocking the enzyme that clears it, which may cause serious side effects. Avoid ergotamine for 2 weeks after abametapir, or use a different lice treatment, and let your pharmacist or doctor coordinate the timing. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Abametapir and Ergotamine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How is the Abametapir and Ergotamine interaction managed?
Both drugs can be managed safely with a little planning. The key point is timing. Do not start with fear: keep taking medicines as prescribed and talk with your care team before making changes. Tell your pharmacist or doctor that you use ergotamine (Ergomar) before an abametapir lice treatment is applied. Your team will usually avoid ergotamine for about 2 weeks after abametapir is applied, since… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Abametapir or Ergotamine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: XEGLYZE(TM) topical lotion, abametapir topical lotion. Dr Reddy’s Laboratories Inc (per FDA), Princeton, NJ, 2020. DailyMed
Keep reading about Abametapir
Keep reading about Ergotamine
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