Letermovir Injection and Ergotamine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Letermovir Injection
Ergotamine
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 alkaloids exposure and an increased risk of ergotism
Interaction Deep Dive
Coadministration of letermovir and ergot alkaloids is contraindicated as this may result in increased concentrations of ergot alkaloids, which may lead to an increased the risk for ergotism1.
Why it happens (mechanism)
Inhibition of CYP3A-mediated metabolism by letermovir
Literature reports
1 report — tap to read
a) In a drug interaction study, coadministration of letermovir (oral 240 mg once daily) with a CYP3A substrate, midazolam (1 mg single dose IV) led to increased AUC, Cmax and C24hr of midazolam by 47%, 5% and 174%, respectively. And, coadministration of letermovir (oral 240 mg once daily) with midazolam (2 mg single dose orally) led to increased AUC and Cmax of midazolam by 125% and 72%, respectively 1.
Common questions
Can I take Letermovir Injection and Ergotamine together?
Increased ergot alkaloids exposure and an increased risk of ergotism Always confirm with your pharmacist or prescriber before making any change.
How serious is the Letermovir Injection and Ergotamine interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
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 Letermovir Injection 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: PREVYMIS(R) oral tablets, oral pellets, intravenous injection, letermovir oral tablets, oral pellets, intravenous injection. Merck Sharp & Dohme Corp (per FDA), Rahway, NJ, 2024. DailyMed
Keep reading about Letermovir Injection
Keep reading about Ergotamine
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