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D.H.E. 45 (injection)

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

Medically reviewed by on Dec 5, 2019 – Written by Cerner Multum

What is D.H.E. 45?

D.H.E. 45 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.

D.H.E. 45 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.

D.H.E. 45 should not be used to treat common tension headaches or any headache that seems to be different from your usual migraine headaches. This medicine is not for daily use.

D.H.E. 45 may also be used for purposes not listed in this medication guide.

Important Information

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 D.H.E. 45 can cause even greater decreases in blood flow than this medicine used alone, which can lead to dangerous side effects. Tell your doctor about all other medications you are using.

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.

Before taking this medicine

Do not use this medication if you are allergic to D.H.E. 45 or other ergot medicine such as Ergomar, Cafergot, Migergot, Migranal, or Methergine. Do not use this medicine 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 D.H.E. 45 can cause even greater decreases in blood flow than this medicine used alone, which can lead to dangerous side effects. Do not use this medicine if you are also using any of the following medications:

D.H.E. 45 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. D.H.E. 45 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 D.H.E. 45?

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.

D.H.E. 45 is injected into a muscle. You may be shown how to use injections at home. Do not self-inject D.H.E. 45 if you do not fully understand how to give the injection and properly dispose of used needles and syringes.

Use D.H.E. 45 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.

D.H.E. 45 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 D.H.E. 45 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 D.H.E. 45 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 D.H.E. 45?

Do not use D.H.E. 45 within 24 hours before or after using another migraine headache medicine, including:

Grapefruit and grapefruit juice may interact with D.H.E. 45 and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor.

D.H.E. 45 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 D.H.E. 45 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.

What other drugs will affect D.H.E. 45?

Many drugs can interact with D.H.E. 45. Below is just a partial list. Tell your doctor if you are using:

This list is not complete and other drugs may interact with D.H.E. 45. 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.

Further information

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.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.