Dihydroergotamine
Class: Non-selective alpha-Adrenergic Blocking Agents
- Ergot Alkaloids
VA Class: CN105
CAS Number: 6190-39-2
Brands: D.H.E. 45, Migranal
Warning
Possible serious and/or life-threatening cerebral and/or peripheral ischemia when administered concomitantly with potent CYP3A4 inhibitors (see Interactions); concomitant use contraindicated.
Introduction
Ergot alkaloid.
Uses for Dihydroergotamine
Vascular Headaches
Acute treatment of migraine attacks (with or without aura) or cluster headaches.
One of several preferred initial therapies in moderate to severe migraines or mild to moderate migraines that respond poorly to NSAIAs.
IV treatment of intractable migraines† (e.g., status migrainosus†); usually used in combination with IV antiemetic.
Not recommended for management of hemiplegic or basilar migraine or for prophylaxis or chronic daily management of migraine.
Other Uses
Used in combination with low-dose heparin therapy for prevention of postoperative DVT and pulmonary embolism; generally has been replaced by other more effective therapies (e.g., low molecular weight heparin alone, warfarin).
Dihydroergotamine Dosage and Administration
General
- Vascular Headaches
Administer as soon as possible after onset of first symptoms of vascular headache.
After administering the initial dose, patient should lie down and relax in a quiet, darkened room.
Administration
Administer by IM, IV, or sub-Q injection or by nasal inhalation using a spray pump.
Administer by nasal inhalation or by IM, sub-Q, or direct IV injection for the acute treatment of migraine; if self-administration by parenteral route is desired, sub-Q injection generally is preferred because of ease of administration.
Administer by IM, sub-Q, or direct IV injection for the acute treatment of cluster headaches; sub-Q injection generally is preferred for self-administration because of ease of administration.
Administer by direct IV injection or continuous IV infusion† for the acute treatment of intractable migraines in an inpatient setting.
Dihydroergotamine preparations are not recommended for prolonged daily use.
Intranasal Administration
Nasal solution intended for topical intranasal use only, and must not be injected.
Prior to initial use, assemble and fully prime the spray pump (i.e., spray 4 times). Consult the manufacturer’s patient instructions for information on assembly, priming, and use of the nasal spray pump.
Spray once in each nostril; wait 15 minutes and spray once again in each nostril. Do not tilt head back or inhale through nose while administering the drug.
Discard nasal spray applicator (with any remaining drug in opened ampul) 8 hours after assembly.
IV Administration
For solution and drug compatibility info.
