methysergide
Last reviewed 01/2018
Methysergide is a 5HT influencing drug that is used in the prophylactic treatment of migraine. It should only be administered under hospital supervision.
Action:
- may prevent migraine by blocking 5HT2 receptors on cerebral vessels and central neurons
Contraindications:
- patients with vascular disease because of its vasoconstrictor action
Side effects:
- retroperitoneal, cardiac valvular and pleural fibrosis
A Europe - wide review concluded that there is a risk of fibrosis (mainly retroperitoneal fibrosis) associated with methysergide treatment. This side effect may be serious and in some cases irreversible or fatal. Healthcare professionals should note the following advice to help minimise the risks
Advice for healthcare professionals (1):
- Methysergide should only be used for prophylaxis of:
- severe intractable migraine (with or without aura) with functional disability in adults when treatment with standard medicines has failed. Previous treatment must have included medicines of other classes for at least 4 months at the maximum tolerated dose
- episodic and chronic cluster headache in adults when treatment with standard medicines has failed. Previous treatment must have included medicines of at least two classes for at least 2 months each
- Methysergide should no longer be used to treat diarrhoea caused by carcinoid disease Methysergide should only be started and supervised by specialised physicians with experience in the treatment of migraine and cluster headache
- People should be screened for fibrosis at the start of treatment and at least every 6 months thereafter. Screening must include heart ultrasonography, abdominal MRI, and pulmonary function tests.
- Treatment must be discontinued if symptoms suggesting fibrosis occur unless an alternative cause is confirmed
- The continued need for methysergide treatment must be reassessed every 6 months using a treatment-free interval of at least 4 weeks between treatment courses
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