Hydergine The First FDAApproved Antidementia Medication

Hydergine is derived from ergot alkaloids (present in rye fungus) that are also used in antimigraine medications. The drug company Sandoz (now part of Novartis) began to study hydergine after it learned that ergot alkaloids were used by nontraditional practitioners to lower a pregnant mother's blood pressure during childbirth. Sandoz's goal was to use hydergine to lower blood pressure and the risk of stroke; this didn't pan out, but they did manage to get it approved as a treatment for dementia.

From the 1980s into the early 1990s, I saw a large number of patients suffering from dementia who took hydergine. General practitioners or internists usually prescribed it to these patients. On occasion, I myself prescribed hydergine to patients with dementia when, out of desperation, family members insisted that I prescribe something, anything, even if there wasn't any solid evidence supporting the medication's use.

At that time, hydergine was the only medication approved in the United States for the treatment of dementia. If the data on this compound were presented to today's hypervigilant FDA, it probably would not win approval as a memory-enhancing medication. In the patients with dementia who took hydergine, I observed the following:

no change in memory a rare patient or two who became more alert with increased mental arousal no obvious side effects at the standard doses recommended in the Physicians' Desk Reference

In other words, I thought of it as similar to placebo, but in the absence of other available options, it wasn't such a bad choice. My approach in prescribing such a medication was to make the patient and family members fully aware that the chances of significant improvement were extremely low, but that it might be worth a shot given the lack of other available options.

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