Dihydroergotamine (dihydroergotamine mesylate)

Available as dihydroergotamine mesylate; dosage expressed in terms of the salt.

Administer dihydroergotamine intranasally or by IM, IV, or subcutaneous injection for acute treatment of migraine. Administer by direct IV injection or continuous IV infusion+ for the acute treatment of intractable migraines in an inpatient setting.

Administer dihydroergotamine by IM, IV, or subcutaneous injection for acute treatment of cluster headaches.

If the drug is being self-administered, the patient should be counseled on proper use and administration technique.

No dosing information is available for this tab.

No dosing information is available for this tab.

There is no enhanced messaging for this drug.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

*Concomitant therapy with strong inhibitors of the cytochrome P-450 (CYP) 3A4 isoenzyme (e.g., clarithromycin, erythromycin, itraconazole, ketoconazole, nelfinavir, ritonavir).

*Known or suspected ischemic heart disease (e.g., angina pectoris, history of myocardial infarction, documented silent ischemia) or clinical symptoms or findings consistent with coronary artery vasospasm (including Prinzmetal's variant angina).

*Uncontrolled hypertension.

*Recent use (i.e., within 24 hours) of a 5-HT1 receptor agonist (e.g., sumatriptan), ergotamine-containing or ergot-type medication or methysergide.

*Basilar or hemiplegic migraine.

*Known peripheral arterial disease, sepsis, severe renal or hepatic impairment, or following vascular surgery.

*Known hypersensitivity to ergot alkaloids. For the dihydroergotamine subcutaneous autoinjector, known hypersensitivity to dihydroergotamine, ergot alkaloids, latex, or any excipients in the formulation.

*Concomitant use of peripheral and central vasoconstrictors.

There are no contraindication contraindications for this drug.

There are no severe contraindications for this drug.

There are no moderate contraindications for this drug.

Adverse effects of dihydroergotamine injection include vasospasm, paresthesia, hypertension, dizziness, anxiety, dyspnea, headache, flushing, diarrhea, rash, increased sweating, and pleural and retroperitoneal fibrosis after long-term use.

The most common adverse effects of dihydroergotamine nasal spray and powder (>1% of patients) include rhinitis, nausea, altered sense of taste, application site reactions, dizziness, vomiting, somnolence, pharyngitis, and diarrhea.

There are no severe adverse reactions for this drug.

There are no less severe adverse reactions for this drug.

No enhanced messaging available.

Safety and efficacy of dihydroergotamine not established in children.

Available data from published literature indicate an increased risk of preterm delivery associated with dihydroergotamine use during pregnancy. Data collected over decades have found no increased risk of major birth defects or miscarriage. In animal reproduction studies, adverse developmental effects were observed in rats and rabbits following intranasal administration of dihydroergotamine during pregnancy (decreased fetal body weight and/or skeletal ossification) and lactation (decreased body weight and impaired reproductive function in offspring) at doses not associated with maternal toxicity. Dihydroergotamine-induced intrauterine growth retardation has been attributed to reduced uteroplacental blood flow resulting from prolonged vasoconstriction of the uterine vessels and/or increased myometrial tone.

Avoid use of dihydroergotamine during pregnancy.

There are no data on the presence of dihydroergotamine in human milk; however, ergotamine is present in human milk. Vomiting, diarrhea, weak pulse, and unstable blood pressure have been reported in breast-fed infants exposed to ergotamine. Ergot alkaloids inhibit prolactin secretion, which may reduce milk supply. Because of the potential for reduced milk supply and serious adverse effects in the breast-fed infant, advise patients not to breast-feed during treatment with dihydroergotamine and for 3 days after the last dose. Breast milk supply during this time should be pumped and discarded.

The manufacturers make no specific dosage recommendations for geriatric patients. In general, dose selection should be cautious, starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function and of concomitant disease or other drug therapy.

Experience with intranasal dihydroergotamine in patients 65 years of age and older is insufficient to determine whether they respond differently than younger adults. In general, dose selection should be cautious, starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function and of concomitant disease or other drug therapy.