Dihydroergotamine

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Generic Name: Dihydroergotamine Brand Name(s): Generics only. No brands available.

Uses

What is Dihydroergotamine used for?

Dihydroergotamine is commonly used to treat migraine headaches and cluster headaches. It is not recommended for migraines that affect only one side of the brain (hemiplegic migraine) or the base of the brain/neck area (basilar migraine), or to prevent migraines from occurring.

Dihydroergotamine is an ergot medication that helps narrow widened blood vessels in the head, thereby reducing the throbbing effects of these headaches.

How should I take Dihydroergotamine?

Inject this medication into a vein, into a muscle, or under the skin as directed by your doctor. Dosage is based on your medical condition and response to treatment. Usually, this medication should be used only as needed. It is not meant for long-term daily use. This medication works best if it is taken as the first signs of the headache occur. If you wait until the headache has worsened, the medication may not work as well.

If your headache returns or you have no relief from the first dose, you may repeat the dose 1 hour after the first dose, but only if instructed to do so by your doctor.

If this medication is given into a muscle or under the skin, a third dose may be given 1 hour after the second dose if needed. Do not use more than 3 milliliters in 24 hours or 6 milliliters in a week.

If this medication is given into a vein, do not use more than 2 milliliters in 24 hours or 6 milliliters in a week.

If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. The solution is normally clear and colorless. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.

Other “ergot” drugs (e.g., ergotamine, methysergide), or “triptan-type” drugs (e.g., sumatriptan) should not be used within 24 hours of this drug.

If you are using drugs for migraine attacks on 10 or more days each month, the drugs may actually make your headaches worse (medication overuse headache). Do not use medications more often or for longer than directed. Tell your doctor if you need to use this medication more often, or if the medication is not working as well, or if your headaches get worse.

How do I store Dihydroergotamine?

Dihydroergotamine is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Dihydroergotamine in the bathroom or the freezer. There may be different brands of Dihydroergotamine that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Dihydroergotamine down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Dihydroergotamine?

Before using this medication, tell your doctor or pharmacist if you are allergic to it; or to other ergot alkaloids (e.g., ergotamine); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: blood circulation disease (e.g., peripheral vascular disease such as arteriosclerosis, thrombophlebitis, Raynaud’s disease), uncontrolled high blood pressure, heart/blood vessel disease (e.g., coronary artery disease, stroke, angina, heart attack), liver disease, kidney disease, severe blood infection (sepsis), recent blood vessel surgery.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: diabetes, family history of heart disease, high blood pressure (controlled), high cholesterol, stomach/intestinal problems (e.g., ischemic bowel syndrome), smoking/tobacco use, permanent ending of menstrual periods due to age/surgery/hormonal changes (post-menopausal).

This drug may make you dizzy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages. Remember that alcohol may be a cause of headaches.

Using tobacco/nicotine products while using this medication can increase the risk of serious side effects such as heart problems (such as chest pain, fast/slow/irregular heartbeat) and decreased blood supply to the brain/hands/feet. Do not use tobacco while taking this medication. If you smoke, talk to your doctor about how to stop smoking.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

This medication must not be used during pregnancy. It may harm an unborn baby. Discuss the use of reliable forms of birth control (such as condoms, birth control pills) with your doctor. If you become pregnant or think you may be pregnant, tell your doctor right away.

This drug may pass into breast milk and could have undesirable effects on a nursing infant. Therefore, breast-feeding is not recommended while using this drug. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Dihydroergotamine during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking this Dihydroergotamine. This Dihydroergotamine is pregnancy risk category X according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Dihydroergotamine?

Dizziness, drowsiness, headache, nausea, vomiting, diarrhea, flushing, or increased sweating may occur. If any of these effects persist or worsen, tell your doctor.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: slow/fast/irregular heartbeat, tingling/pain/coldness in the fingers/toes, whitish fingers/toes/nails, loss of feeling in the fingers/toes, bluish hands/feet, muscle pain/weakness in the arms/legs, severe stomach/abdominal pain, lower back pain, signs of kidney problems (such as change in the amount of urine).

Get medical help right away if any of these rare but very serious side effects occur: difficult/painful breathing, chest pain, confusion, slurred speech, weakness on one side of the body, vision problems.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Dihydroergotamine?

Some products that may interact with this drug include: bronchodilators/decongestants/stimulants (such as epinephrine, pseudoephedrine, methylphenidate, amphetamine).

If you also take “triptan” migraine drugs (e.g., sumatriptan, rizatriptan), you will need to separate your “triptan” dose from your dose of this medication to reduce the risk of serious side effects. Ask your doctor how long you should wait between your doses of these drugs.

Some products have ingredients that could raise your heart rate or blood pressure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or other migraine medications).

Dihydroergotamine may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Dihydroergotamine?

Dihydroergotamine may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Dihydroergotamine?

Dihydroergotamine may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Dihydroergotamine.

What is the dose of Dihydroergotamine for an adult?

Usual Adult Dose for Migraine

Parenteral:

Initial dose: 1 mg IM/IV/subcutaneously

-Additional 1 mg dose may be given at hourly intervals as needed not to exceed daily maximums

Maximum doses:

-IV: 2 mg/24 hours; 6 mg/7-day period

-IM/subcutaneously: 3 mg/ 24 hours; 6 mg/ 7-day period

Nasal Spray:

Initial dose: 0.5 mg (1 spray) intranasally into both nostrils; repeat in 15 minutes

Total dose: 2 mg (2 sprays in each nostril 15 minutes apart)

-Acute doses greater than 2 mg have not been shown to provide additional benefits

Maximum doses: 3 mg/24 hours; 4 mg/7-day period

Comments:

-This drug should only be used where a clear diagnosis of migraine headache has been established.

-This drug is not intended for chronic daily administration.

Use: For the acute treatment of migraine headaches with or without aura.

Usual Adult Dose for Cluster Headache

Initial dose: 1 mg IM/IV/subcutaneously

-Additional 1 mg dose may be given at hourly intervals as needed not to exceed daily maximums

Maximum doses:

-IV: 2 mg/24 hours; 6 mg/7-day period

-IM/subcutaneously: 2 mg/ 24 hours; 6 mg/ 7-day period

Comments:

-This drug is not intended for chronic daily administration.

Use: For the acute treatment of cluster headache episodes.

Renal Dose Adjustments

Severe renal impairment: Use is contraindicated

Liver Dose Adjustments

Severe hepatic impairment: Use is contraindicated

Dose Adjustments

Elderly: Use with caution; no information on use in patients over 65 years as they were excluded from clinical trials

Other Comments

Administration advice:

Nasal Spray:

-For intranasal use only; each vial contains one complete dose

-To assemble, lift tab to bend blue cover back, completely remove blue cover, metal seal, and stopper; insert spray pump into vial and turn clockwise until tight

-Prime pump with 4 sprays prior to first use

-Spray once into each nostril, wait 15 minutes and repeat

-Do not tilt head back or sniff through your nose while spraying or immediately after

Ampules:

-May be administered IM/IV or subcutaneously

-For patients who self administer, they should receive instructions for subcutaneous use; subcutaneous dose should be administered into middle of thigh, well above the knee

Storage requirements:

-Ampules and Nasal spray (unopened): Protect from light; store below 77F (25C); do not refrigerate or freeze

-Ampule: Dispose of ampule 1 hour after opening

-Nasal spray: Dispose of nasal spray 8 hours after opening

General:

-This drug should only be used when a clear diagnosis of migraine headache has been established; not indicated for the treatment of hemiplegic or basilar migraine.

-Patients at risk of coronary artery disease (CAD) should have a satisfactory cardiovascular (CV) evaluation prior to initiating therapy; due to the possibility of CV testing not detecting underlying CAD, it is strongly recommended that the first dose be administered in a medically equipped facility with an ECG performed after dosing.

Monitoring:

-Consider ECG monitoring after first dose in patients with risk factors for coronary artery disease (CAD)

-Patients with CAD risk factors, and those who acquire risk factors predictive of CAD, should undergo periodic cardiovascular evaluation

Patient advice:

-Patients should report any numbness or tingling in toes or fingers, muscle pain in the arms and legs, weakness in legs, chest pain, changes in heart rate, swelling, or itching to their healthcare provider promptly; patients should be aware of the risk of serious cardiovascular side effects and the importance of seeking medical advice promptly if they occur.

-Patients should be advised to talk with their doctor or pharmacist before taking any new medications or supplements.

-Patients should be instructed not to take more than the prescribed amount of medication without talking to their healthcare provider.

-This drug may cause dizziness; patients should avoid driving or operating machinery until adverse effects are determined.

-Advise patient to speak to physician or health care professional if pregnant, intend to become pregnant, or are breastfeeding.

What is the dose of Dihydroergotamine for a child?

The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is Dihydroergotamine available?

Dihydroergotamine is available in the following dosage forms and strengths:

  • Injection Solution

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Dihydroergotamine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: January 22, 2018 | Last Modified: January 22, 2018

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