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Hydergine: The First FDA-Approved 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
(PDR)

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.

Properties of Hydergine

1. Increases blood flow and glucose utilization in the brain.
2. Indirectly helps decrease free-radical formation.
3. Stimulates the production of the neurotransmitters norepinephrine and dopamine, which help
to maintain attention and alertness (mental arousal, vigilance). These actions may