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Migranal Nasal Spray

Generic Name: dihydroergotamine nasal (dye hye droe er GOT a meen)
Brand Name: Migranal Nasal Spray

What is Migranal Nasal Spray (dihydroergotamine nasal)?

Dihydroergotamine nasal causes vasoconstriction (narrowing of blood vessels). It also affects blood flow patterns that are associated with migraine and cluster headaches.

Dihydroergotamine nasal is used to treat migraine headaches. This medication will also not prevent a migraine headache.

Dihydroergotamine nasal should not be used to treat a cluster headache.

Dihydroergotamine nasal may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about Migranal Nasal Spray (dihydroergotamine nasal)?

This medication can cause birth defects in an unborn baby. Do not use if you are pregnant. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

Dihydroergotamine nasal can pass into breast milk and may harm a nursing baby. Do not use this medication if you are breast-feeding a baby.

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

There are many other medicines that can cause serious medical problems if you take them together with dihydroergotamine nasal. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

What should I discuss with my healthcare provider before using Migranal Nasal Spray (dihydroergotamine nasal)?

Do not use this medication if you are allergic to dihydroergotamine or other ergot medicine such as ergotamine (Ergomar, Ergostat, Cafergot, Ercaf, Wigraine), ergonovine (Ergotrate), methylergonovine (Methergine), or methysergide (Sansert).

Do not use dihydroergotamine nasal if you are pregnant or breast-feeding, or if you have:

  • angina (chest pain);

  • a history of stroke or heart attack;

  • arteriosclerosis (hardening of the arteries);

  • uncontrolled high blood pressure (hypertension);

  • severe liver disease;

  • severe kidney disease; or

  • a serious infection.

Before using dihydroergotamine nasal, tell your doctor if you are allergic to any drugs, or if you have:

  • uncontrolled high blood pressure (hypertension);

  • heart disease or a history of heart surgery;

  • high cholesterol;

  • diabetes;

  • if you are a woman who has had a hysterectomy or gone through menopause;

  • if you are a man over 40 years of age; or

  • if you smoke or are overweight.

If you have any of these conditions, you may not be able to use dihydroergotamine nasal, or you may need a dosage adjustment or special tests during treatment.

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

Dihydroergotamine nasal passes into breast milk and may be harmful to a nursing infant. Dihydroergotamine nasal may also decrease milk production. Do not use dihydroergotamine nasal if you are breast-feeding a baby.

How should I use Migranal Nasal Spray (dihydroergotamine nasal)?

Use this medication exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the instructions on your prescription label.

Dihydroergotamine nasal will not treat a non-migraine headache. Do not use this medication to treat a common headache that does not feel like your usual migraine headache.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

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.

Use dihydroergotamine nasal at the first sign of a migraine headache.

Before using the medication, you must first prime the nasal sprayer by pumping 4 sprays into the air. This will assure that there is enough medicine in the pump device to deliver the correct dose when you spray it into your nose.

Use one spray in each nostril. Wait 15 minutes before using a second spray in each nostril. If you still have migraine symptoms after using the medication a second time, call your doctor.

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.

Do not give this medication to anyone else, even if they have the same headache symptoms you have. Dihydroergotamine nasal 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 dihydroergotamine nasal at room temperature away from moisture and heat. Throw away the vial and sprayer after you finish using it to treat one headache episode.

What happens if I miss a dose?

Since dihydroergotamine nasal is used as needed, you are not likely to be on a daily dosing schedule. 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.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a dihydroergotamine nasal overdose may include numbness, tingling, cold feeling, or bluish coloring in your hands or feet, nausea, vomiting, stomach pain, confusion, unusual thoughts or behavior, severe headache, blurred vision, trouble concentrating, chest pain, feeling light-headed or fainting, slow or shallow breathing, or seizure (black-out or convulsions).

What should I avoid while using Migranal Nasal Spray (dihydroergotamine nasal)?

Do not use another migraine headache medicine within 24 hours before or after using dihydroergotamine nasal. This includes almotriptan (Axert), sumatriptan (Imitrex), zolmitriptan (Zomig), rizatriptan (Maxalt), or naratriptan (Amerge).

Grapefruit and grapefruit juice may interact with dihydroergotamine nasal and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.

Migranal Nasal Spray (dihydroergotamine nasal) side effects

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

Stop using this medication and call your doctor right away if you have any of these serious side effects:

  • sudden numbness or weakness, especially on one side of the body;

  • sudden headache, confusion, problems with vision, speech, or balance;

  • chest pain;

  • weakness, pain, or swelling in one or both legs;

  • fast, slow, or uneven heart rate;

  • swelling or itching in any part of your body;

  • muscle pain in your arms or legs;

  • feeling light-headed, fainting; or

  • numbness, tingling, or cold feeling in your fingers or toes.

Keep using the medication and talk with your doctor if you have any of these less serious side effects:

  • runny or stuffy nose;

  • nose bleed;

  • burning, pain, numbness, tingling, dryness, or other irritation in your nose or throat;

  • unusual or unpleasant taste in your mouth; or

  • nausea, vomiting.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

See also: Side effects (in more detail)

What other drugs will affect Migranal Nasal Spray (dihydroergotamine nasal)?

There are many other medicines that can cause serious medical problems if you take them together with dihydroergotamine nasal. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

Before using dihydroergotamine nasal, tell your doctor if you are using any of the following drugs:

  • cold or allergy medications;

  • amiodarone (Cordarone, Pacerone);

  • cimetidine (Tagamet);

  • ciprofloxacin (Cipro);

  • cyclosporine (Gengraf, Neoral, Sandimmune);

  • metronidazole (Flagyl, Protostat);

  • nicotine (Nicoderm, Nicorette);

  • sibutramine (Meridia);

  • zileuton (Zyflo);

  • an "SSRI" antidepressant such citalopram (Celexa), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), nefazodone (Serzone), sertraline (Zoloft), or paroxetine (Paxil);

  • antibiotics such as azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin (E-Mycin, E.E.S., Ery-Tab, Erythrocin), itraconazole (Sporanox), clotrimazole (Mycelex Troche), ketoconazole (Nizoral), or troleandomycin (Tao);

  • HIV medication such as amprenavir (Agenerase), atazanavir (Reyataz), foramprenavir (Lexiva), delavirdine (Rescriptor), indinavir (Crixivan), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Norvir), saquinavir (Invirase, Fortovase) and others; or

  • heart or blood pressure medication such as acebutolol (Sectral), atenolol (Tenormin), betaxolol (Kerlone), bisoprolol (Zebeta), carteolol (Cartrol), carvedilol (Coreg), diltiazem (Cardizem, Dilacor, Tiazac), esmolol (Brevibloc), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), penbutolol (Levatol), pindolol (Visken), propranolol (Inderal, InnoPran), sotalol (Betapace), timolol (Blocadren), or verapamil (Calan, Covera, Isoptin, Verelan).

If you are using any of these drugs, you may not be able to use dihydroergotamine nasal, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect dihydroergotamine nasal. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist has information about dihydroergotamine nasal written for health professionals that you may read.

What does my medication look like?

Dihydroergotamine nasal is available with a prescription under the brand name Migranal. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

  • 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: 1.01. Revision Date: 2007-03-06, 10:29:00.

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