Martindale�s 24th
Compiled and edited by Ivor Hughes

Ergot (B.P.C., I.P.). Secale Cornutum (I.P.); Rye Ergot; Ergot de Seigle; Mutterkorn; Cornezuelo de centeno.

The sclerotium of the fungus Claviceps purpurea (Hypocreaceae) developed in the ovary of the rye, Secale cereale (Gramineae), containing not less than 0-2% of total alkaloids of which not less than 15% consists of water-soluble alkaloids. I.P. specifies not less than 0-15% of total alkaloids and not less than 0'023% of water-soluble alkaloids.

Foreign Pharmacopoeias: In all pharmacopoeias examined except Mex. and U.S. but in U.S.N.F. The specified content of alkaloids varies but is usually lower than the B.P.C. minima. U.S.N.F. has not less than 0-15% of total alkaloids and not less than 0-01% of water-soluble alkaloids. Ergot should be thoroughly dried, kept entire, and stored in a cool place. If powdered and stored without the immediate removal of the fat the alkaloidal content decreases.

Note. When Ergot or Powdered Ergot is prescribed, Prepared Ergot is dispensed.

Toxic Effects. Acute poisoning is rare and usually results from the use of large quantities as an abortifacient. Symptoms are nausea, vomiting, diarrhoea, thirst, coldness of the skin, rapid and weak pulse, numbness and tingling of the extremities, confusion and unconsciousness. Chronic ergotism may result from therapeutic overdosage, especially following administration to patients with severe infection (such as puerperal fever), liver disease, or hyperthyroidism. Circulatory disturbances are usually the first symptoms to appear, including coldness of the skin, severe muscle pains, and vascular stasis resulting in dry peripheral gangrene. Other symptoms are headache, nausea, vomiting, diarrhoea, dizziness and weakness of the legs. Nervous symptoms are confusion, depression, drowsiness, hemiplegia and convulsions. Epidemic ergot poisoning, arising from the ingestion of ergotised rye bread, is now seldom seen.  Two forms of epidemic toxicity have been described, a gangrenous form characterised by agonising pain of the extremities of the body followed by dry gangrene of the peripheral parts and a rarer nervous type giving rise to paroxysmal, epileptiform convulsions. These two types of ergotism rarely, if ever, occur together.

Antidotes. Treatment of acute poisoning is symptomatic. In cases of chronic poisoning treatment consists in complete withdrawal of the drug and attempts to prevent gangrene by maintaining an adequate circulation in the affected parts. Vasodilators such as the Choline esters, nitrites or papaverine may be tried, together with mechanical procedures to restore the circulation. In more severe cases, impending gangrene may be averted by the use of paravertebral block or ganglionic blocking agents. Nausea and vomiting may be relieved by atropine. Muscle pains which do not respond to massage or exercise may be relieved by the intravenous injection of 10 ml. of Injection of Calcium Gluconate

Uses. Ergot stimulates the smooth muscle of the body, especially of the blood vessels and uterus, and its use is almost entirely confined to obstetrics. Because it produces prolonged uterine contraction it is especially employed to check post-partum haemorrhage; it is dangerous if administered in the early stages of labour. The action of ergot depends on its alkaloidal content, especially of ergotamine, ergotoxine and ergometrine. Of these, ergometrine is the only one which produces a rapid oxytocic effect by mouth and the use of this alkaloid is often preferred to preparations of the whole drug because of the more exact dosage which can be given, the specific action on the uterine muscle, and the fact that it has much less tendency to give rise to gangrene. Ergot is usually given as capsules or tablets of prepared ergot, or as extract or liquid extract of ergot. The liquid extract loses its activity very rapidly, especially when diluted in mixtures.

Prepared Ergot (B.P.C., Ind. P.). Pulvis Secalis Cornuti Standardisatus (I.P., Egyp. P.). Powdered and defatted ergot adjusted to contain 0'2% of alkaloids, of which not less than 15% consists of water-soluble alkaloids. Protect from light and moisture in a cool place.
Dose: 150 to 500 mg. (2� to 8 grains).

Caps. Ergot. (B.N.F.). Ergot Capsules; Capsules of Prepared Ergot. Unless otherwise specified, capsules each containing 2� grains of prepared ergot are supplied.

Ext. Ergot. (B.P.C. 1949). Extract of Ergot. A soft extract prepared by macerating and percolating defatted ergot with alcohol (50%) acidified with sulphuric acid. It contains, when fresh, 0-5% w/w of alkaloids, and after storage, not less than 0-35%. Protect from moisture in a cool place. Dose: 60 to 200 mg. (1 to 3 grains).

Ext. Ergot. Liq. (B.P. 1914). Prepared by macerating ergot 100 g. with 500 ml. of water for 12 hours, straining, repeating the maceration with 250ml. of water, straining, evaporating the mixed liquids to 70 ml., adding 37-5 ml. of alcohol (90%), setting aside for an hour and then filtering. The product measures about 100 ml. 
Dose: 0-6 to 2 ml. (10 to 30 minims).

Liquid Extract of Ergot (B.P.C.). Ext. Ergot. Liq.; Ergot Fluidextract; Extractum Secalis Cornuti Fluidum. Prepared by macerating and percolating defatted ergot with alcohol (50%) acidified with tartaric acid. It contains, when fresh, 0'06% w/v of alkaloids, and after storage not less than 0-04%. It loses activity on keeping, the rate being rapid at ordinary temperatures but slow at 0�. Store in completely filled containers in as cool a place as possible.
Dose: 0-6 to 1.2 ml. (10 to 20 minims). A similar liquid extract is included in many foreign pharmacopoeias. U.S.N.F, has a 1 in 1 extract.

STABILITY. Liquid extract of ergot deteriorates rapidly and even when stored in a refrigerator in completely filled bottles of blue or amber glass it should not be kept for more than 9 months. (B. K. Ghosh et al., Indian Pharm., 1948, 3, 81.)

Mist. Ergot. (N.F. 1939). Liquid extract of ergot (B.P. 1914) 15 m., chloroform water to � fluid oz.
Dose: 15 ml. (� fl. oz.). Note. Ergot is best administered as capsules or tablets of prepared ergot.

Nicholson's Pill. Extract of ergot (B.P.  1914) 1� gr., quinine sulphate 1� gr., dry extract of nux vomica � gr., digitalis � gr.; potato starch and lactose to 5 gr. Usually prepared in tablet form.�Retail Chem., 1953, 24, 96.

Tablets of Ergot (B.P.C.). Tab. Ergot. (B.N.F.); Tablets of Prepared Ergot. Unless otherwise specified, tablets each containing 2� grains of prepared ergot are supplied. Store in air-tight containers in a cool place. The B.N.F. directs that the tablets be crushed before being swallowed.

Tinct. Ergot. Ammon. (B.P.C. 1934). Ammoniated Tincture of Ergot. Prepared by percolating ergot 25 g. with dilute solution of ammonia 10 ml. and alcohol (60%) to 100 ml.
Dose: 2 to 4 ml. (30 to 60 minims).  

See also; Oxytocics Martindale's 24th

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