Dihydroergotamine Injection and Nasal Spray
(dye hye droe er got' a meen)
Do not take dihydroergotamine if you are taking any of the following medications: antifungals such as itraconazole (Sporanox) and ketoconazole (Nizoral); HIV protease inhibitors such as indinavir (Crixivan), nelfinavir (Viracept), and ritonavir (Norvir); or macrolide antibiotics such as clarithromycin (Biaxin), erythromycin (E.E.S., E-Mycin, Erythrocin), and troleandomycin (TAO).
WHY is this medicine prescribed?
Dihydroergotamine is used to treat migraine headaches. Dihydroergotamine is in a class of medications called ergot alkaloids. It works by tightening blood vessels in the brain and by stopping the release of natural substances in the brain that cause swelling.
HOW should this medicine be used?
Dihydroergotamine comes as a solution to inject subcutaneously (under the skin) and as a spray to be used in the nose. It is used as needed for migraine headaches. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use dihydroergotamine exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
Dihydroergotamine can damage the heart and other organs if it is used too often. Dihydroergotamine should be used only to treat a migraine that is in progress. Do not use dihydroergotamine to prevent a migraine from beginning or to treat a headache that feels different than your usual migraine. Dihydroergotamine should not be used every day. Your doctor will tell you how many times you may use dihydroergotamine each week.
You may receive your first dose of dihydroergotamine in your doctor's office so that your doctor can monitor your reaction to the medication and be sure that you know how to use the nasal spray or administer the injection correctly. After that, you may spray or inject dihydroergotamine at home. Be sure that you and anyone who will be helping you inject the medication read the manufacturer's information for the patient that comes with dihydroergotamine before using it for the first time at home.
If you are using the solution for injection, you should never reuse syringes. Dispose of syringes in a puncture resistant container. Ask your doctor or pharmacist how to dispose of the puncture resistant container.
To use the solution for injection, follow these steps:
To use the nasal spray, follow these steps:
Are there OTHER USES for this medicine?
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
What SPECIAL PRECAUTIONS should I follow?
Before using dihydroergotamine,
- tell your doctor and pharmacist if you are allergic to dihydroergotamine, other ergot alkaloids such as bromocriptine (Parlodel), ergonovine (Ergotrate), ergotamine (Cafergot, Ercaf, others), methylergonovine (Methergine), and methysergide (Sansert), or any other medications.
- do not take dihydroergotamine within 24 hours of taking ergot alkaloids such as bromocriptine (Parlodel), ergonovine (Ergotrate), ergotamine (Cafergot, Ercaf, others), methylergonovine (Methergine), and methysergide (Sansert); or other medications for migraine such as frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig).
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: beta blockers such as propranolol (Inderal); cimetidine (Tagamet); clotrimazole (Lotrimin); cyclosporine (Neoral, Sandimmune); danazol (Danocrine); delavirdine (Rescriptor); diltiazem (Cardizem, Dilacor, Tiazac); epinephrine (Epipen); fluconazole (Diflucan); isoniazid (INH, Nydrazid); medications for colds and asthma; metronidazole (Flagyl); nefazodone (Serzone); oral contraceptives (birth control pills); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil ), and sertraline (Zoloft); saquinavir (Fortovase, Invirase); verapamil (Calan, Covera, Isoptin, Verelan); zafirlukast (Accolate); and zileuton (Zyflo). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have a family history of heart disease and if you have or have ever had high blood pressure; high cholesterol; diabetes; Raynaud's disease (a condition that affects the fingers and toes); any disease that affects your circulation or arteries; sepsis (a severe infection of the blood); surgery on your heart or blood vessels; a heart attack; or kidney, liver, lung, or heart disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using dihydroergotamine, call your doctor immediately.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are using dihydroergotamine.
- tell your doctor if you use tobacco products. Smoking cigarettes while using this medication increases the risk of serious side effects.
What SPECIAL DIETARY instructions should I follow?
Talk to your doctor about drinking grapefruit juice while taking this medicine.
What SIDE EFFECTS can this medicine cause?
Dihydroergotamine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away. Most of these symptoms, especially those that affect the nose, are more likely to occur if you use the nasal spray:
- stuffy nose
- tingling or pain in the nose or throat
- dryness in the nose
- taste changes
- upset stomach
- extreme tiredness
Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:
- color changes, numbness or tingling in fingers and toes
- muscle pain in arms and legs
- weakness in arms and legs
- chest pain
- speeding or slowing of heart rate
- cold, pale skin
- slow or difficult speech
Dihydroergotamine may cause other side effects. Call your doctor if you have any unusual problems while using this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).
What should I know about STORAGE and DISPOSAL of this medication?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Do not refrigerate or freeze. Dispose of unused medication for injection 1 hour after you open the ampule. Dispose of unused nasal spray 8 hours after you open the ampule.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.
What should I do in case of OVERDOSE?
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include:
- numbness, tingling, and pain in fingers and toes
- blue color in fingers and toes
- slowed breathing
- upset stomach
- blurred vision
- stomach pain
What OTHER INFORMATION should I know?
Keep all appointments with your doctor. Your doctor may order certain tests to check your body's response to dihydroergotamine.
Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Please note, not all procedures included in this resource library are available at Allegiance Health or performed by Allegiance Health physicians.
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