Associated with fibrotic valve thickening (e.g. aortic, mitral, tricuspid), usually with long-term, chronic use. Vasospasm or vasoconstriction can occur (use should be avoided in patients at risk or predisposed to vascular effects of ergot alkaloids). Cerebral hemorrhage, subarachnoid hemorrhage, and stroke occurred following injection. Ergotism is usually associated with overdosage or prolonged chronic use (resulting in peripheral vascular ischemia and possible gangrene). Pleural and retroperitoneal fibrosis reported (rare). Caution in risk factors for cardiovascular disease. Ergot alkaloids are contraindicated with potent inhibitors of CYP3A4 (includes protease inhibitors, azole antifungals, and some macrolide antibiotics). Contraindicated in severe hepatic or renal dysfunction. Use cautiously if at all in the elderly. Local irritation to nose and throat can occur with nasal spray. May cause rare feelings of numbness or tingling of fingers, toes or face, or drowsiness.