dihydroergotamine

Generic Name: dihydroergotamine (nasal) (dye HYE droe er GOT a meen)
Brand Name: Migranal

What is dihydroergotamine nasal?

Dihydroergotamine is an ergot medicine. It works by narrowing the blood vessels around the brain.

Dihydroergotamine nasal is used to a treat migraine headache attack.

Dihydroergotamine nasal will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks.

Dihydroergotamine nasal should not be used to treat common tension headaches or any headache that seems to be different from your usual migraine headaches.

Dihydroergotamine nasal may also be used for purposes not listed in this medication guide.

What is the most important information I should know about dihydroergotamine nasal?

This medication can harm an unborn baby or a nursing baby. Do not use dihydroergotamine nasal if you are pregnant or breast-feeding.

You should not use dihydroergotamine nasal if you have a history of heart disease, angina (chest pain), blood circulation problems, heart attack or stroke, or if you have coronary artery disease, uncontrolled high blood pressure, severe liver or kidney disease, a serious infection, or have recently had heart or blood vessel surgery.

Slideshow: Living with Your Migraines: Tips for Treatment and Prevention

Some medicines can cause severe decreases in blood flow and dangerous side effects when used with dihydroergotamine. Your doctor may need to change your treatment plan if you use any of the following drugs: antibiotics, antifungals, or medicines to treat HIV or AIDS.

What should I discuss with my healthcare provider before using dihydroergotamine nasal?

You should not use this medicine if you are allergic to dihydroergotamine or similar medicines (ergotamine, ergonovine, methylergonovine, methysergide, Cafergot, Ergomar, Methergine, Sansert, and others), or if you have:

  • a history of heart disease, angina (chest pain), blood circulation problems, coronary artery disease (hardening of the arteries), or history of a heart attack or stroke;

  • uncontrolled high blood pressure;

  • severe liver or kidney disease;

  • a serious infection called sepsis; or

  • if you have recently had heart or blood vessel surgery (such as bypass surgery).

This medication can harm an unborn baby or a nursing baby. Do not use dihydroergotamine nasal if you are pregnant or breast-feeding.

Some medicines can cause severe decreases in blood flow and dangerous side effects when used with dihydroergotamine. Your doctor may need to change your treatment plan if you use any of the following drugs:

  • an antibiotic--clarithromycin, erythromycin;

  • antifungal medicine--itraconazole, ketoconazole; or

  • HIV or AIDS medication--indinavir, nelfinavir, ritonavir.

To make sure dihydroergotamine nasal is safe for you, tell your doctor if you have:

  • breathing problems;

  • high blood pressure;

  • ischemic bowel disease;

  • liver or kidney disease; or

  • risk factors for coronary artery disease (such as diabetes, menopause, smoking, being overweight, having high blood pressure or high cholesterol, having a family history of coronary artery disease, being older than 40 and a man, or being a woman who has had a hysterectomy).

FDA pregnancy category X. This medication can harm an unborn baby or cause birth defects. Do not use dihydroergotamine nasal if you are pregnant. Tell your doctor right away if you become pregnant during treatment. Use effective birth control while you are using this medication.

Dihydroergotamine nasal can pass into breast milk and may harm a nursing baby. Do not breast-feed while taking dihydroergotamine nasal.

How should I use dihydroergotamine nasal?

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended. Tell your doctor if the medicine seems to stop working as well in treating your migraine attacks. Dihydroergotamine is not for daily use.

Dihydroergotamine nasal spray is absorbed quickly through your nasal passages and is for use only in the nose. The nasal spray liquid should not be injected into the body.

Your doctor may want to give your first dose of this medicine in a hospital or clinic setting to quickly treat any serious side effects that occur.

Dihydroergotamine nasal comes in a bottle (vial) with a nasal sprayer attachment. Do not open the vial and attach the sprayer until you are ready to use the medication. A new vial and sprayer should be used for each new headache episode.

Before using the medicine, prime the nasal spray by pumping exactly 4 sprays into the air.

Use the first dose of dihydroergotamine as soon as you notice headache symptoms, or after an attack has already begun. Use one spray in each nostril, and after 15 minutes use a second spray in each nostril, for a total of 4 sprays.

Do not tilt your head back while you are using the nasal spray, and do not sniff through your nose during use or just after use. Throw away the vial and sprayer after you finish using it to treat one headache episode, or no longer than 8 hours after opening the vial.

If you still have migraine symptoms after using a total of 4 sprays, call your doctor before using any more. Do not use more than 6 total sprays of dihydroergotamine nasal in any 24-hour period. Do not use more than 8 total sprays of this medication over a period of 7 days.

If you use dihydroergotamine nasal long-term, your doctor may want to check your heart function periodically using an electrocardiograph or ECG (sometimes called an EKG), a machine that measures electrical activity of the heart. This will help your doctor determine if it is still safe for you to use this medication. Do not miss any scheduled visits to your doctor.

Do not share this medication with another person, even if they have the same headache symptoms you have. Dihydroergotamine can be dangerous if it is used to treat headache in a person who has not been diagnosed by a doctor as having true migraine headaches.

Store at room temperature away from moisture and heat. Do not keep this medicine in a refrigerator or freezer.

What happens if I miss a dose?

Since dihydroergotamine is used on an as-needed basis, you are not likely to miss a dose.

Do not use more than 6 sprays of dihydroergotamine nasal per day or more than 8 sprays per week.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of dihydroergotamine can be fatal.

What should I avoid while using dihydroergotamine nasal?

Do not use dihydroergotamine nasal within 24 hours before or after using another migraine headache medicine, including:

  • another ergot medicine such as ergotamine (Ergomar, Ergostat, Cafergot, Ercaf, Wigraine), ergonovine (Ergotrate), methylergonovine (Methergine), or methysergide (Sansert); or

  • almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), sumatriptan (Imitrex), rizatriptan (Maxalt, Maxalt-MLT), or zolmitriptan (Zomig).

Avoid using a cough or cold medicine that contains a decongestant (such as phenylephrine or pseudoephedrine), while you are using dihydroergotamine nasal.

Grapefruit and grapefruit juice may interact with dihydroergotamine nasal and lead to unwanted side effects. Discuss the use of grapefruit products with your doctor.

Dihydroergotamine nasal side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using dihydroergotamine nasal and call your doctor at once if you have:

  • sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with vision or balance;

  • chest pain or heavy feeling, pain spreading to the jaw or shoulder, nausea, sweating, general ill feeling;

  • muscle pain in your arms or legs, leg weakness;

  • numbness or tingling and a pale or blue-colored appearance in your fingers or toes;

  • swelling or itching in any part of your body;

  • stomach cramps, diarrhea that may be bloody; or

  • dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

Common side effects may include:

  • dizziness;

  • nausea, vomiting;

  • runny nose;

  • altered sense of taste; or

  • soreness or irritation in your nose.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Dihydroergotamine Dosing Information

Usual Adult Dose for Migraine:

IM or subcutaneous: Initial dose: 1 mg given as quickly as possible after the first symptom of headache. Additional 1 mg doses can be given hourly until the headache has stopped or a total dose of 3 mg has been reached. The total weekly dose should not exceed 6 mg.

IV: Initial dose: 1 mg given as quickly as possible after the first symptom of headache. Additional 1 mg doses can be given hourly until the headache has stopped or a total dose of 2 mg has been reached. The total weekly dose should not exceed 6 mg.

Intranasal: 1 spray (0.5 mg) into each nostril (total = 1 mg). Repeat if needed within 15 minutes to a maximum of 4 sprays (2 mg) per day. The total weekly dose should not exceed 8 sprays (4 mg).

Usual Adult Dose for Cluster Headache:

IM or subcutaneous: Initial dose: 1 mg given as quickly as possible after the first symptom of headache. Additional 1 mg doses can be given hourly until the headache has stopped or a total dose of 3 mg has been reached. The total weekly dose should not exceed 6 mg.

IV: Initial dose: 1 mg given as quickly as possible after the first symptom of headache. Additional 1 mg doses can be given hourly until the headache has stopped or a total dose of 2 mg has been reached. The total weekly dose should not exceed 6 mg.

What other drugs will affect dihydroergotamine nasal?

Many drugs can interact with dihydroergotamine nasal. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start or stop using during treatment with dihydroergotamine nasal, especially:

  • an antibiotic such as telithromycin;

  • antifungal medicine such as fluconazole; or

  • nefazodone (an antidepressant).

This list is not complete and many other drugs can interact with dihydroergotamine nasal. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

Where can I get more information?

  • Your pharmacist can provide more information about dihydroergotamine nasal.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 3.01. Revision Date: 2013-10-07, 9:36:44 AM.

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