Indinavir and Dihydroergotamine Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Indinavir
No brand names on recordDihydroergotamine Injection
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.
What happens
Increased ergot derivative exposure and an increased risk of ergotism (nausea, vomiting, vasospastic ischemia)
Interaction Deep Dive
Concomitant use of indinavir and ergot derivatives may result in increased plasma concentration of ergot derivatives. Coadministration of ergot derivatives with potent CYP3A4 inhibitors, such as indinavir, has been associated with acute ergot toxicity characterized by vasospasm and ischemia of the extremities31, with some cases resulting in amputation 2. Ergot derivatives and protease inhibitors are both metabolized by CYP3A4 enzymes, and the competition for metabolism could result in increased plasma concentrations of an ergot derivative, such as dihydroergotamine. Because of the potential for serious and/or life-threatening reactions that can occur with increased plasma concentrations of an ergot derivative, the concurrent use of a protease inhibitor and an ergot derivative is contraindicated 1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism by indinavir
Literature reports
2 reports — tap to read
a) A 30-year-old HIV-positive male was stabilized for 14 months on lamiVUDine 300 mg daily, stavudine 60 mg daily, indinavir 2400 mg daily, and cotrimoxazole for PCP prophylaxis when he was prescribed ergotamine tartrate for a migraine headache. He took a total of four tablets, each containing ergotamine tartrate 1 mg and caffeine 100 mg, over a period of two days. Five days after his last dose of ergotamine, he presented with numbness and cyanosis of his toes, followed by intermittent claudication of the lower limb. His symptoms worsened, and he was admitted to a hospital six days later when his lower limb peripheral pulses were absent. A translumbar aortography showed bilateral and segmental vasospasm affecting the deep and superficial femoral and popliteal arteries consistent with ergotism. Indinavir is a potent inhibitor of cytochrome P450 3A enzymes which metabolize ergotamine. In this specific case, the ergotism developed after the discontinuation of the medication, which is compatible with the long half-life of the drug 4.
b) Pharmacokinetic interactions have been reported in patients treated orally with ergot alkaloids (eg, increased levels of ergotamine) and troleandomycin, presumably due to inhibition of CYP3A4 metabolism of the alkaloids by troleandomycin 1.
Common questions
Can I take Indinavir and Dihydroergotamine Injection together?
Increased ergot derivative exposure and an increased risk of ergotism (nausea, vomiting, vasospastic ischemia) Always confirm with your pharmacist or prescriber before making any change.
How serious is the Indinavir and Dihydroergotamine Injection interaction?
It is rated contraindicated. These should generally not be used together.
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 strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Indinavir or Dihydroergotamine Injection 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 (4)
- Product Information: Migranal(R) nasal spray, dihydroergotamine mesylate nasal spray. Bausch Health US LLC (per FDA), Bridgewater, NJ, 2022. DailyMed
- Product Information: CAFERGOT(R) oral tablets, caffeine and ergotamine tartrate oral tablets. Novartis Pharmaceuticals Corporation, East Hanover, NJ, 2003. DailyMed
- Product Information: CRIXIVAN(R) oral capsules, indinavir sulfate oral capsules. Merck Sharp & Dohme Corp (per manufacturer), Whitehouse Station, NJ, 2016. DailyMed
- Rosenthal E, Sala F, Chichmanian RM, et al: Ergotism related to concurrent administration of ergotamine tartrate and indinavir (letter). JAMA 1999; 281:987. PubMed
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