Concurrent Therapy with CYP 3A4

Peripheral Ischemia Following Coadministration With Strong CYP3A4 Iinhibitors

• Serious and/or life threatening peripheral ischemia has been reported with coadministration of this drug with potent CYP 3A4 inhibitors (including protease inhibitors and macrolide antibiotics).
• Because CYP3A4 inhibition elevates the serum levels of ergotamine and dihyergotamine, the risk of vasospasm leading to cerebral ischemia and/or ischemia of the extremities is increased.
• Concurrent use of these drugs is contraindicated.