Migraine and headache:
Indications for: Dihydroergotamine
Acute treatment of migraine headache or cluster headache episodes.
1mL IV at 1 hour intervals; max 2 doses/day. Or, 1mL IM or SC at 1-hour intervals; max 3 doses/day. For all: max 6 doses/week. Do not use chronically.
Ischemic heart disease. Coronary artery vasospasm (eg, Prinzmetal's angina) or myocardial ischemia. Peripheral artery disease. Sepsis. Post-vascular surgery. Uncontrolled hypertension. Other significant cardiovascular disease. Severely impaired hepatic or renal function. Basilar or hemiplegic migraine. Concomitant potent CYP3A4 inhibitors (eg, ritonavir, nelfinavir, indinavir, erythromycin, clarithromycin, troleandmycin, ketoconazole, itraconazole) or other vasoconstrictors. Within 24 hours of sumatriptan, zolmitriptan, other 5-HT1 agonists, or ergot-type drugs.
Peripheral ischemia following coadministration with potent CYP3A4 inhibitors.
Confirm diagnosis. Exclude underlying cardiovascular disease, supervise 1st dose, and consider monitoring ECG in patients with likelihood of unrecognized coronary disease (eg, postmenopausal women, men over age 40, hypercholesterolemia, hypertension, obesity, diabetes, smokers, strong family history). Monitor cardiovascular function in long-term intermittent use. Compromised circulation. Medication overuse headache. Elderly. Pregnancy: avoid. Nursing mothers: not recommended (during and for 3 days after the last dose).
See Contraindications. Potentiated by CYP3A4 inhibitors (eg, protease inhibitors, macrolides, azole antifungals, saquinavir, nefazodone, fluoxetine, fluvoxamine, grapefruit juice, zileuton), propranolol, nicotine.
Numbness, pain, weakness of extremities, epigastric distress, tachycardia or bradycardia, nausea, vomiting, localized edema and itching, cardiac or cerebrovascular events; myocardial and peripheral vascular ischemia or vasoconstriction (ergotism: discontinue if occurs); rare: fibrotic complications.
Formerly known under the brand name D.H.E. 45.
Fecal. Half-life: ~9 hours.