• Migraine and headache

Dihydroergotamine Generic Name & Formulations

General Description

Dihydroergotamine mesylate 1mg/mL; for IM, IV, or SC inj.

Pharmacological Class

Ergot alkaloid.

How Supplied

Contact supplier

Dihydroergotamine Indications


Acute treatment of migraine headache or cluster headache episodes.

Dihydroergotamine Dosage and Administration


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.


Not established.

Dihydroergotamine Contraindications


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.

Dihydroergotamine Boxed Warnings

Boxed Warning

Peripheral ischemia following coadministration with potent CYP3A4 inhibitors.

Dihydroergotamine Warnings/Precautions


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).

Dihydroergotamine Pharmacokinetics


Hepatic. 93% plasma protein bound.


Fecal. Half-life: ~9 hours.

Dihydroergotamine Interactions


See Contraindications. Potentiated by CYP3A4 inhibitors (eg, protease inhibitors, macrolides, azole antifungals, saquinavir, nefazodone, fluoxetine, fluvoxamine, grapefruit juice, zileuton), propranolol, nicotine.

Dihydroergotamine Adverse Reactions

Adverse Reactions

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.

Dihydroergotamine Clinical Trials

See Literature

Dihydroergotamine Note


Formerly known under the brand name D.H.E. 45.

Dihydroergotamine Patient Counseling

See Literature