Migranal

Generic Name: dihydroergotamine (injection) (dye HYE droe er GOT a meen)
Brand Name: D.H.E. 45

What is Migranal (dihydroergotamine (injection))?

Dihydroergotamine is in a group of drugs called ergot alkaloids (ER-got AL-ka-loids). It works by narrowing the blood vessels around the brain and affects blood flow patterns that are associated with certain types of headaches.

Dihydroergotamine injection is used to treat a migraine or cluster headache attack. This medication will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks.

Dihydroergotamine injection should not be used to treat common tension headaches or any headache that seems to be different from your usual migraine headaches. Dihydroergotamine is not for daily use.

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

What is the most important information I should know about Migranal (dihydroergotamine (injection))?

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

Using certain medications together with dihydroergotamine can cause even greater decreases in blood flow than dihydroergotamine used alone, which can lead to dangerous side effects. Tell your doctor about all other medications you are using.

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

Also tell your doctor about all of your medical conditions, especially breathing problems, high blood pressure, ischemic bowel disease, liver or kidney disease, or risk factors for heart disease.

Never use more than your prescribed dose of dihydroergotamine. An overdose can be fatal.

What should I discuss with my healthcare provider before using Migranal (dihydroergotamine (injection))?

Do not use this medication if you are allergic to dihydroergotamine or other ergot medicine such as Ergomar, Cafergot, Migergot, Migranal, or Methergine. Do not use dihydroergotamine injection if you are pregnant or breast-feeding, or if you have:

  • a history of heart disease, angina (chest pain), blood circulation problems, or history of a heart attack or stroke;

  • coronary artery disease or "hardening of the arteries";

  • 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).

Using certain medications together with dihydroergotamine can cause even greater decreases in blood flow than dihydroergotamine used alone, which can lead to dangerous side effects. Do not use dihydroergotamine if you are also using any of the following medications:

  • conivaptan (Vaprisol), imatinib (Gleevec), isoniazid (for treating tuberculosis), or nefazodone (an antidepressant);

  • diclofenac (Arthrotec, Cataflam, Voltaren, Flector Patch, Solareze);

  • clarithromycin (Biaxin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin), or telithromycin (Ketek);

  • clotrimazole (Mycelex Troche), itraconazole (Sporanox), ketoconazole (Extina, Ketozole, Nizoral, Xolegal), or voriconazole (Vfend);

  • heart or blood pressure medication such as diltiazem (Cardizem, Dilacor, Tiazac), nicardipine (Cardene), quinidine (Quin-G), or verapamil (Calan, Covera, Isoptin, Verelan); or

  • HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), saquinavir (Invirase, Fortovase), or ritonavir (Norvir).

Dihydroergotamine can cause rare but serious side effects on the heart, including heart attack or stroke. To make sure you can safely take dihdroergotamine, tell your doctor if you have any of these other conditions:

  • breathing problems;

  • high blood pressure;

  • ischemic bowel disease;

  • liver or kidney disease; or

  • coronary heart disease (or risk factors that include 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. Dihydroergotamine can cause birth defects. Do not use 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 can pass into breast milk and may harm a nursing baby. Dihydroergotamine may also decrease milk production. Do not use if you are breast-feeding a baby.

How should I use Migranal (dihydroergotamine (injection))?

Use exactly as prescribed by your doctor. Never use more than your prescribed dose of dihydroergotamine. Tell your doctor if the medicine seems to stop working as well in treating your migraine attacks.

Dihydroergotamine is injected into a muscle. You may be shown how to use injections at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles and syringes.

Use dihydroergotamine injection as soon as you notice headache symptoms, or after an attack has already begun.

If your headache does not completely go away, you may use a second injection after 1 hour has passed, and a third injection if needed after another hour has passed (a total of 3 injections).

If you still have migraine symptoms after using 3 injections, call your doctor before using any more. If your headache goes away and then comes back, you may use the medication again if it has been at least 6 hours since your last injection.

Do not use more than a total of 3 injections of this medication in any 24-hour period. Do not use more than a total of 6 injections over a period of 7 days.

Dihydroergotamine injection should be clear and colorless. Do not use if the liquid has changed colors or has particles in it. Call your doctor for a new prescription.

If you use dihydroergotamine 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.

Store at room temperature away from moisture, heat, and light. Do not use if the expiration date on the label has passed.

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 3 injections of dihydroergotamine per day or more than 6 injections per week.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of dihydroergotamine can be fatal. Overdose symptoms may include some of the serious side effects listed in this medication guide.

What should I avoid while using Migranal (dihydroergotamine (injection))?

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

  • another ergot medicine such as ergotamine (Ergomar, Cafergot, Migergot), dihydroergotamine (Migranal), or methylergonovine (Methergine); or

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

Grapefruit and grapefruit juice may interact with dihydroergotamine injection and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor.

Migranal (dihydroergotamine (injection)) 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 dihydroergotamine and call your doctor at once if you have a serious side effect such as:

  • fast or slow heart rate, swelling or itching in any part of your body;

  • chest pain spreading to the arm or shoulder, and nausea, sweating, or general ill feeling;

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

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

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

  • stomach cramps, diarrhea that may be bloody;

  • cough with stabbing chest pain and trouble breathing; or

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

Less serious side effects may include:

  • headache, dizziness, feeling anxious;

  • diarrhea;

  • sweating, mild skin rash, redness or tingly feeling under your skin.

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)

What other drugs will affect Migranal (dihydroergotamine (injection))?

Many drugs can interact with dihydroergotamine. Below is just a partial list. Tell your doctor if you are using:

  • zileuton (Zyflo);

  • nicotine (Nicoderm, Nicorette);

  • cold or allergy medications, diet pills, stimulants, or medication to treat ADHD (such as Ritalin or Adderall);

  • an antidepressant such fluoxetine (Prozac), sertraline (Zoloft), and others;

  • fluconazole (Diflucan) or other antifungal medication; or

  • heart or blood pressure medication such as atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor, Toprol), propranolol (Inderal, InnoPran), and others.

This list is not complete and other drugs may interact with dihydroergotamine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist can provide more information about dihydroergotamine injection.
  • 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: 5.02. Revision Date: 2010-12-15, 5:01:39 PM.

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