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HYDERGINE
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Chemical- Co-dergocrine Mesylate (Ergoloid Mesylate)
Adverse Effects- Side-effects occasionally reported with co-dergocrine
mesylate include nausea, vomiting, headache, blurred vision, skin
rashes, nasal stuffiness, flushing of the skin, dizziness, bradycardia,
and orthostatic hypertension. Local irritation has been reported
following sublingual administration. Effects on the Cardiovascular
System- Of 8 patients given co-dergocrine mesylate 1.5 mg three times
daily for the treatment of dementia, 3 developed severe sinus
bradycardia associated with general deterioration in their condition,
necessitating withdrawal of the treatment. (1) However, Cohen (2)
reported that no sinus bradycardia had been observed in 40 elderly
patients in whom the dose was built up to 1.5 mg three times daily
over 3 weeks.
1. Cayley ACD, et al. Sinus bradycardia following treatment with
Hydergine for cerebrovascular insufficiency. Br Med J 1975- 4:
384-5.
2. Cohen C. Sinus bradycardia following treatment with Hydergine. Br
Med J 1975- 4: 581.
Uses and Administration- Unlike the natural ergot alkaloids, co-dergocrine
mesylate has only limited vasoconstrictor effects. It is used with the
intention of treating symptoms of mild to moderate impairment of
mental function in the elderly in doses of 3 or 4.5 mg daily by mouth,
preferably before meals. Higher doses have also been used. It is also
given sublingually in doses of 3 mg daily. Doses of 300 mcg have been
given intramuscularly, subcutaneously, or by intravenous infusion. In
some countries, co-dergocrine mesylate has been used in the treatment
of hypertension and in peripheral vascular disease. Co-dergocrine
mesylate has been used similarly to the mesylate.
References to some uses of co-dergocrine mesylate.
1. Bellani M, et al. Treatment of hypertension in the elderly: a
controlled clinical trial of dihydroergotoxine mesylate in comparison
with nifedipine. Curr Ther Res 1983- 34: 1014-22.
2. Hajioff J, Wallace M. Effect of co-dergocrine mesylate on
tardive dyskinesia: a preliminary report. Psychopharmacology (Berlin)
1983- 79: 1-3.
3. Uehlinger DE, et al. Cardiovascular regulation and lipoprotein
profile during administration of co-dergocrine in essential
hypertension. Eur J Clin Pharmacol 1989- 36: 119-25.
Senile Dementia- There is still much uncertainty about the use of
co-dergocrine mesylate in the treatment of senile dementia. It was
originally thought to act as a peripheral and cerebral vasodilator and
vasodilatation was considered an effective treatment for senile
dementia due to cerebral ischaemia. However, cerebral ischaemia is no
longer believed to be central to the problem. Co-dergocrine mesylate
is now classified as a metabolic enhancer. Optimal dosage has not been
established- standard oral doses are 3 mg daily in the US and 4.5 mg
daily in Europe and Japan, but in some countries as much as 12 mg
daily is used without reports of serious side-effects. Some workers
have found little difference between doses of 3 and 6 mg daily in
patients with senile dementia, whereas others have concluded that 6mg
daily was superior in a study of patients with multi-infarct
dementia's or mental disturbances after stroke. The overall trend
seems to be to use larger doses, orally rather than sublingually, for
longer periods. A review in 1979 focused on 22 controlled studies of
co-dergocrine mesylate in senile dementia, but although each study
showed significant improvement on some behavioral or psychological
measure, conclusions as to the therapeutic usefulness of co-dergocrine
mesylate were guarded. Improvements ranging from 11 to 21% were
calculated for mood depression, confusion, mental alertness,
orientation, recent memory, emotional lability, and self-care from 4
studies submitted to the FDA, but specific clinical effects reported
have varied widely. Patients selected for evaluation of co-dergocrine
mesylate should be limited to those with senile dementia of the
Alzheimer or multi-infarct type and the 2 groups should be considered
separately. Patients with advanced disease are unlikely to benefit.
Although many clinicians continue to regard co-dergocrine mesylate as
a placebo it is one of the few potentially effective treatments
available for senile dementia of the Alzheimer type. It is suggested
that doses of at least 6 mg daily should be given for 6 months and
treatment continued, possibly at a lower dose, if improvement or
stabilization of decline is seen- if treatment has not been successful
it should be abandoned. Hollister LE, Yesavage J. Ergoloid mesylates
for senile dementias: unanswered questions. Ann Intern Med 1984- 100:
894-8.
Further references to co-dergocrine mesylate in senile
dementia.
1. Huber F, et al. Effects of long-term ergoloid mesylates (`Hydergine')
administration in healthy pensioners: 5-year results. Curr Med Res
Opin 1986- 10: 256-79.
2. Orgogozo JM, Spiegel R. Critical review of clinical trials in
senile dementia- I. Postgrad Med J 1987- 63: 237-40.
Liquid- With regard to the liquid Hydergine, each mark on the oral
dropper is equivalent to 0.5mg of Hydergine. Less liquid Hydergine is
required over tabulated Hydergine because the liquid is more easily
absorbed through the mouth membranes. Draw up the required amount of
liquid into the dropper, place into the mouth and release, and allow
the liquid to move around the mouth and under the tongue, swallow the
remainder.
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