Tofago

Tofago is an oral migraine medication containing Ergotamine Tartrate 1 mg and Caffeine 100 mg. It belongs to the Ergot Alkaloid + Xanthine drug class and is a Thai generic.

Ergotamine works by binding to multiple receptors (serotonin, dopamine, adrenergic), causing cranial blood vessel constriction and reducing the vasodilation that causes migraine pain.

Caffeine serves dual roles: enhancing Ergotamine absorption from the GI tract and providing additional vasoconstrictive effects.

Important: Ergotamine is an older migraine drug now largely replaced by Triptans (e.g., Sumatriptan). Triptans are more receptor-specific, have fewer side effects, and are safer overall.

Acute migraine: Tofago is used to treat acute migraine headaches. Must be taken as soon as symptoms begin — the earlier, the more effective.

Dosage:

• Start with 1-2 tablets at onset of symptoms
• Repeat every 30 minutes if needed
• Maximum: 6 tablets per attack, 10 tablets per week

Key limitations:

• Not a migraine preventive — for acute treatment only
• Should not be used more than 10 days/month — risk of medication overuse headache
• Not first-line treatment — doctors recommend trying Paracetamol/Ibuprofen or Triptans first

Dosage:

• Take 1-2 tablets immediately at the onset of migraine
• Repeat 1 tablet every 30 minutes if symptoms persist
• Maximum per attack: 6 tablets (Ergotamine 6 mg)
• Maximum per week: 10 tablets (Ergotamine 10 mg)

Important:

• Take as early as possible when aura or headache begins
• Do not use for more than 5 consecutive days
• Wait at least 4 days before repeating
• Do not use more than 10 days/month to prevent medication overuse headache

If Tofago is ineffective: Consult your doctor about switching to a Triptan (e.g., Sumigran — Sumatriptan), which is the current first-choice migraine treatment.

Common side effects:

• Nausea, vomiting — the most common
• Abdominal pain
• Tingling or numbness in fingers and toes (paraesthesia)
• Fatigue
• Muscle pain

Serious side effects (stop and seek immediate medical attention):

• Vasospasm — severe blood vessel constriction causing pale, cold, numb, burning limbs
• Ergotism — from excessive or prolonged Ergotamine use, causing tissue ischaemia potentially leading to gangrene
• Medication overuse headache — rebound headaches from using pain medications too frequently
• Chest pain, palpitations
• Severe allergic reaction

Warning: Ergotamine side effects are significantly more severe than Triptans, which is the main reason Triptans are now recommended as first-choice.

Do not use:

• Cardiovascular disease — coronary artery disease, uncontrolled hypertension, peripheral vascular disease (PVD), Raynaud's disease
• Pregnancy — Ergotamine causes uterine contractions, potentially harming the foetus
• Severe liver or kidney disease
• Sepsis
• Allergy to Ergotamine or any other ingredient

Drug interactions (contraindicated):

• Triptans (Sumatriptan, Rizatriptan etc.) — must wait at least 24 hours; do not combine as this increases vasospasm risk
• Macrolide antibiotics (Erythromycin, Clarithromycin) — increase Ergotamine to toxic levels
• Protease inhibitors (Ritonavir, Nelfinavir) — CYP3A4 inhibition causes Ergotamine accumulation
• Azole antifungals (Ketoconazole, Itraconazole)

Tofago vs. Sumigran (Sumatriptan): Sumigran is a Triptan, the current first-choice migraine treatment. Significantly safer than Ergotamine, with selective 5-HT1B/1D receptor action, fewer side effects, and no ergotism risk. The only downside is higher cost.

Tofago vs. Paracetamol/Ibuprofen: Simple analgesics are the first-line choice for mild-to-moderate migraine. Cheap and safe, but may be insufficient for severe migraine. Tofago is appropriate when simple analgesics fail.

Summary: Recommended migraine treatment ladder: Paracetamol/Ibuprofen → Triptan (Sumatriptan) → Ergotamine (Tofago). Use Tofago only when safer options are ineffective.

Medication Overuse Headache (MOH) is a chronic headache caused by overuse of pain medications or migraine drugs, also known as rebound headache.

Cause: When pain/migraine medications are used more than 10-15 days per month for 3+ months, the brain adapts, and when the drug wears off, headaches recur, leading to more medication use — creating a vicious cycle.

Ergotamine carries particularly high MOH risk due to its tendency to be used frequently at high doses.

Prevention:

• Do not use Tofago more than 10 days per month
• Do not use for more than 5 consecutive days
• If you need medication frequently, consult your doctor about migraine preventive therapy

Tofago is a pharmacist-dispensed medication. You can order online from Intimo Life.

Can I buy Tofago online?

Yes. Order through Intimo Life — select the product, consult with a licensed pharmacist online, and receive your medication at home.

Do I need a prescription?

A doctor's prescription is not required, but the medication must be dispensed by a licensed pharmacist. At Intimo Life, our pharmacist will review your symptoms and health history to confirm suitability before shipping.

How does Intimo Life ship orders?

We deliver nationwide in Thailand with discreet packaging — no product names on the outside.