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Migranal Side Effects

Generic Name: dihydroergotamine

Note: This document contains side effect information about dihydroergotamine. Some of the dosage forms listed on this page may not apply to the brand name Migranal.

For the Consumer

Applies to dihydroergotamine: nasal spray

Along with its needed effects, dihydroergotamine (the active ingredient contained in Migranal) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur while taking dihydroergotamine:

Less common or rare
  • Chest pain
  • cough, fever, sneezing, or sore throat
  • feeling of heaviness in chest
  • irregular heartbeat
  • itching of the skin
  • numbness and tingling of face, fingers, or toes
  • pain in arms, legs, or lower back
  • pain in back, chest or left arm
  • pale bluish-colored or cold hands or feet
  • shortness of breath or troubled breathing
  • weak or absent pulses in legs
Symptoms of overdose
  • Confusion
  • convulsions (seizures)
  • delirium
  • dizziness
  • headaches
  • nausea and/or vomiting
  • numbness, tingling, and/or pain in the legs or arms
  • shortness of breath
  • stomach pain

Some side effects of dihydroergotamine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Burning or tingling sensation, dryness, soreness, or pain in the nose
  • change in sense of taste
  • diarrhea
  • dizziness
  • dry mouth
  • fatigue
  • headache
  • increased sweating
  • nausea and or vomiting
  • muscle stiffness
  • runny and or stuffy nose
  • sudden sweatings and feelings of warmth
  • sensation of burning, warmth, or heat
  • sore throat
  • sleepiness
  • unexplained nose bleeds
  • unusual tiredness or weakness
Less common
  • Anxiety
  • blurred vision
  • cold clammy skin
  • confusion
  • congestion in chest
  • cough
  • decreased appetite
  • depression
  • difficulty swallowing
  • dizziness or lightheadedness when getting up from a lying or sitting position
  • ear pain
  • eye pain
  • fever
  • heartburn
  • increased watering of eyes
  • increased watering of the mouth
  • increased yawning
  • muscle weakness
  • nervousness
  • pinpoint red spots on skin
  • pounding heartbeat
  • red or irritated eyes
  • ringing or buzzing in ears
  • skin rash
  • stomach pain
  • sudden fainting
  • swelling of face, fingers, feet, or lower legs
  • trembling or shaking of hands or feet
  • trouble in sleeping
  • unusual feeling of well being

For Healthcare Professionals

Applies to dihydroergotamine: injectable solution, nasal spray

General

The most commonly reported adverse events have included nausea and vomiting; with use of the nasal spray, rhinitis, altered sense of taste, and application site reactions have also been reported.

Cardiovascular

Deaths due to cardiac events have been reported with parenteral use, but no cardiac related deaths were reported during clinical studies with the nasal spray. Reports of serious cardiac events with the injection appear to be rare.[Ref]

Uncommon (0.1% to 1%): Edema, palpitation, tachycardia
Rare (less than 0.1%): Hypotension, peripheral ischemia, angina, cardiac valvular fibrosis
Frequency not reported: Acute myocardial infarction, transient myocardial ischemia, ventricular tachycardia, ventricular fibrillation, coronary artery vasospasm, bradycardia, extrasystoles, intermittent claudication, Raynaud's phenomenon
Postmarketing reports: Vasospasm, hypertension, flushing, peripheral ischemia, gangrene[Ref]

Nervous system

Common (1% to 10%): Dizziness, somnolence, paraesthesia
Uncommon (0.1% to 1%): Tremor, hypoesthesia, altered sense of smell
Rare (less than 0.1%): Speech disorder, hyperkinesia, stupor, abnormal gait, depression, aggravated migraine, convulsions
Frequency not reported: Cerebral hemorrhage, subarachnoid hemorrhage, stroke, headache[Ref]

Local

Almost 30% of patients receiving the nasal spray reported irritation in the nose, throat, and/or disturbances in taste. Symptoms of congestion, burning, dryness, paraesthesia, discharge, epistaxis, pain, and soreness, mostly mild to moderate and transient, have been reported. In most (approximately 70%), symptoms resolved within 4 hours. The consequence of extended and repeated use on the nasal mucosa have not been studied.[Ref]

Very common (10% or more): Local irritation (nasal spray; 30%)
Common (1% to 10%): Application site reactions
Uncommon (0.1% to 1%): Local anesthesia[Ref]

Respiratory

Very common (10% or more): Rhinitis (nasal spray; 26%)
Common (1% to 10%): Pharyngitis, sinusitis
Uncommon (0.1% to 1%): Dyspnea, upper respiratory tract infections
Rare (less than 0.1%): Bronchospasm, bronchitis, pleural pain, epistaxis, yawning
Postmarketing reports: Pleural fibrosis[Ref]

Gastrointestinal

Common (1% to 10%): Nausea, vomiting, diarrhea
Uncommon (0.1% to 1%): Abdominal pain, dyspepsia, hiccup, dry mouth
Rare (less than 0.1%): Increased salivation, esophagospasm, anorexia
Frequency not reported: Colonic ischemia
Postmarketing reports: Retroperitoneal fibrosis[Ref]

The most frequent side effect with the use of intravenous dihydroergotamine is nausea. Following intramuscular or intranasal administration, the incidence of nausea is lower.[Ref]

Other

Uncommon (0.1% to 1%): Vertigo, tinnitus, earache, feeling cold, malaise, rigors, fever, fatigue, asthenia[Ref]

Musculoskeletal

Common (1% to 10%): Stiffness
Uncommon (0.1% to 1%): Cramps, myalgia, muscular weakness, dystonia
Rare (Less than 0.1%): Arthralgia, involuntary muscle contractions, rigidity
Frequency not reported: Leg pain, muscle spasms[Ref]

Renal

Frequency not reported: Renal artery spasm[Ref]

Hypersensitivity

Frequency not reported: Hypersensitivity reactions such as skin rash, face edema, urticaria, and dyspnea

Ocular

Uncommon (0.1% to 1%): Photophobia, conjunctivitis, abnormal lacrimation, abnormal vision, periorbital edema
Rare (less than 0.1%): Eye pain

Psychiatric

Uncommon (0.1% to 1%): Nervousness, euphoria, insomnia, impaired concentration
Rare (less than 0.1%): Anxiety

Dermatologic

Uncommon (0.1% to 1%): Petechia, pruritus, rash, cold clammy skin
Rare (less than 0.1%): Papular rash, urticaria, herpes simplex
Frequency not reported: Sweating

Genitourinary

Uncommon (0.1% to 1%): Increased micturition frequency, cystitis
Rare (less than 0.1%): Pelvic inflammation, vaginitis

References

1. Robbins L, Remmes A "Outpatient repetitive intravenous dihydroergotamine." Headache 32 (1992): 455-8

2. "Product Information. D.H.E. 45 (dihydroergotamine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.

3. Malaquin F, Urban T, Ostinelli J, Ghedira H, Lacronique J "Pleural and retroperitoneal fibrosis from dihydroergotamine ." N Engl J Med 321 (1989): 1760

4. Schulman EA, Rosenberg SB "Claudication: an unusual side effect of DHE administration." Headache 31 (1991): 237-9

5. "Drugs for migraine." Med Lett Drugs Ther 37 (1995): 17-20

6. Lipton RB "Ergotamine tartrate and dihydroergotamine mesylate: safety profiles." Headache 37 Suppl (1997): s33-41

7. Backonja M, Beinlich B, Dulli D, Schutta HS "Haloperidol and lorazepam for the treatment of nausea and vomiting associated with the treatment of intractable migraine headaches ." Arch Neurol 46 (1989): 724

8. Henry PY, Larre P, Aupy M, Lafforgue JL, Orgogozo JM "Reversible cerebral arteriopathy associated with the administration of ergot derivatives." Cephalalgia 4 (1984): 171-8

9. Bachner EJ, Konsens RM, Priem L, King T, Froimson AI "Reversible vasospasm in association with the use of heparin and dihydroergotamine." Clin Orthop No. 283 (1992): 261-4

10. Mattsson E, Ohlin A, Balkfors B, Fredin HO, Nilsson P, Bergqvist D "Lower-limb vasospasm and renal failure during postoperative thromboprophylaxis. Case report." Eur J Surg 157 (1991): 289-92

Some side effects of Migranal may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. 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 substances you are taking, check with your doctor, nurse, or pharmacist.

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