What is D.H.E. 45 (Dihydroergotamine)?

Dihydroergotamine is in a group of drugs called ergot alkaloids (ER-got AL-ka-loids). It works by narrowing the blood vessels around the brain. Dihydroergotamine also affects blood flow patterns that are associated with certain types of headaches.
Dihydroergotamine injection is used to treat a migraine or cluster headache attack.
This medication will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks.
Dihydroergotamine injection should not be used to treat common tension headaches or any headache that seems to be different from your usual migraine headaches.
Dihydroergotamine injection may also be used for purposes not listed in this medication guide.

What is the most important information I should know about D.H.E. 45 (Dihydroergotamine)?

This medication can harm an unborn baby or a nursing baby. Do not use dihydroergotamine injection if you are pregnant or breast-feeding.
Do not use this medication if you are allergic to dihydroergotamine or other ergot medicines, or if you have a history of heart disease, angina (chest pain), blood circulation problems, history of a heart attack or stroke, coronary artery disease, uncontrolled high blood pressure, severe liver or kidney disease, a serious infection, if you have recently had heart or blood vessel surgery.
Using certain medications together with dihydroergotamine can cause even greater decreases in blood flow than dihydroergotamine used alone. A severe decrease in blood flow to the brain and other parts of the body can lead to dangerous side effects. Tell your doctor about all other medications you are using, especially antibiotics, antidepressants, heart or blood pressure medications, or medicines to treat HIV or AIDS.
Also tell your doctor about all of your medical conditions, especially breathing problems, high blood pressure, ischemic bowel disease, liver or kidney disease, or risk factors for coronary artery disease (such as diabetes, menopause, smoking, being overweight, having high blood pressure or high cholesterol, having a family history of coronary artery disease, being older than 40 and a man, or being a woman who has had a hysterectomy).
This medication will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks.
Never use more than your prescribed dose of dihydroergotamine. Tell your doctor if the medicine seems to stop working as well in treating your migraine attacks. An overdose of dihydroergotamine can be fatal.

What should I discuss with my healthcare provider before taking D.H.E. 45 (Dihydroergotamine)?

Do not use this medication if you are allergic to dihydroergotamine or other ergot medicine such as ergotamine (Ergomar, Ergostat, Cafergot, Ercaf, Wigraine), ergonovine (Ergotrate), methylergonovine (Methergine), or methysergide (Sansert).
Do not use dihydroergotamine injection if you are pregnant or breast-feeding, or if you have:

a history of heart disease, angina (chest pain), blood circulation problems, or history of a heart attack or stroke
coronary artery disease or “hardening of the arteries”
uncontrolled high blood pressure
severe liver disease
severe kidney disease
a serious infection called sepsis; or
if you have recently had heart or blood vessel surgery (such as bypass surgery)

Using certain medications together with dihydroergotamine can cause even greater decreases in blood flow than dihydroergotamine used alone. A severe decrease in blood flow to the brain and other parts of the body can lead to dangerous side effects. Do not use dihydroergotamine if you are also using any of the following medications:

conivaptan (Vaprisol)
diclofenac (Arthrotec, Cataflam, Voltaren, Flector Patch, Solareze)
imatinib (Gleevec)
isoniazid (for treating tuberculosis)
an antibiotic such as clarithromycin (Biaxin), dalfopristin/quinupristin (Synercid), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin), telithromycin (Ketek), or troleandomycin (Tao)
an antifungal medication such as clotrimazole (Mycelex Troche), itraconazole (Sporanox), ketoconazole (Nizoral), or voriconazole (Vfend)
an antidepressant such as nefazodone
heart or blood pressure medication such as diltiazem (Cardizem, Dilacor, Tiazac), nicardipine (Cardene), quinidine (Quinaglute, Quinidex, Quin-Release), or verapamil (Calan, Covera, Isoptin, Verelan); or
HIV/AIDS medicine such as amprenavir (Agenerase), atazanavir (Reyataz), delavirdine (Rescriptor), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), saquinavir (Invirase, Fortovase), or ritonavir (Norvir)

Dihydroergotamine can cause rare but serious side effects on the heart, including heart attack or stroke. If you have certain conditions, you may need a dose adjustment or special tests to safely use this medication. Before using dihydroergotamine, tell your doctor if you have:

breathing problems
high blood pressure
ischemic bowel disease
liver disease
kidney disease; or
coronary artery disease (or risk factors that include diabetes, menopause, smoking, being overweight, having high blood pressure or high cholesterol, having a family history of coronary artery disease, being older than 40 and a man, or being a woman who has had a hysterectomy)

FDA pregnancy category X. This medication can cause birth defects. Do not use dihydroergotamine if you are pregnant. Tell your doctor right away if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.
Dihydroergotamine passes into breast milk and may be harmful to a nursing infant. Dihydroergotamine may also decrease milk production. Do not use dihydroergotamine if you are breast-feeding a baby.

D.H.E. 45 Side Effects

What are the possible side effects of D.H.E. 45 (Dihydroergotamine)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Stop using dihydroergotamine and call your doctor at once if you have a serious side effect such as:

fast or slow heart rate
chest pain or heavy feeling, pain spreading to the arm or shoulder, and nausea, sweating, or general ill feeling
sudden numbness or weakness, especially on one side of the body
sudden headache, confusion, problems with vision, speech, or balance
muscle pain in your arms or legs
leg weakness
numbness or tingling and a pale or blue-colored appearance in your fingers or toes
swelling or itching in any part of your body
stomach cramps, diarrhea that may be bloody
cough with stabbing chest pain and trouble breathing; or
dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure)

Less serious side effects may include:

headache, dizziness, feeling anxious
diarrhea
warmth, redness, or tingly feeling under your skin; or
sweating, mild skin rash

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

D.H.E. 45 Interactions

What other drugs affect D.H.E. 45 (Dihydroergotamine)?

Many drugs can interact with dihydroergotamine. Below is just a partial list. Tell your doctor if you are using:

zileuton (Zyflo)
cold or allergy medications
nicotine (Nicoderm, Nicorette)
diet pills, stimulants, or medication to treat ADHD (such as Ritalin or Adderall)
an antidepressant such fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), nefazodone (Serzone), paroxetine (Paxil), sertraline (Zoloft), and others
an antifungal medication such as clotrimazole (Mycelex Troche) or fluconazole (Diflucan); or
heart or blood pressure medication such as atenolol (Tenormin), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), and others

This list is not complete and other drugs may interact with dihydroergotamine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

What should I avoid while taking D.H.E. 45 (Dihydroergotamine)?

Do not use dihydroergotamine injection within 24 hours before or after using another migraine headache medicine, including:

another ergot medicine such as ergotamine (Ergomar, Ergostat, Cafergot, Ercaf, Wigraine), ergonovine (Ergotrate), methylergonovine (Methergine), or methysergide (Sansert); or
almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), sumatriptan (Imitrex), rizatriptan (Maxalt, Maxalt-MLT), or zolmitriptan (Zomig)

Grapefruit and grapefruit juice may interact with dihydroergotamine injection and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.

D.H.E. 45 Dosage

How should I take D.H.E. 45 (Dihydroergotamine)?

Use exactly as prescribed by your doctor. Never use more than your prescribed dose of dihydroergotamine. Follow the directions on your prescription label. Tell your doctor if the medicine seems to stop working as well in treating your migraine attacks. Dihydroergotamine is not for daily use.
Dihydroergotamine is injected into a muscle. You may be shown how to use injections at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles and syringes.
Your doctor may want to give your first dose of this medicine in a hospital or clinic setting to quickly treat any serious side effects that occur.
Use the first dose of dihydroergotamine as soon as you notice headache symptoms, or after an attack has already begun. The usual dose of dihydroergotamine injection is 1 milliliter (1 mL) per injection.
If your headache does not completely go away, you may use a second injection after 1 hour has passed, and a third injection if needed after another hour has passed (a total of 3 injections).
If you still have migraine symptoms after using a total of 3 injections, call your doctor before using any more. If your headache goes away and then comes back, you may use the medication again if it has been at least 6 hours since your last injection.
Do not use more than a total of 3 injections of this medication in any 24-hour period. Do not use more than a total of 6 injections over a period of 7 days.
Dihydroergotamine injection should be clear and colorless. Do not use if the liquid has changed colors or has particles in it. Call your doctor for a new prescription.
If you use dihydroergotamine long-term, your doctor may want to check your heart function periodically using an electrocardiograph or ECG (sometimes called an EKG), a machine that measures electrical activity of the heart. This will help your doctor determine if it is still safe for you to use this medication. Do not miss any scheduled visits to your doctor.
Do not give this medication to anyone else, even if they have the same headache symptoms you have. Dihydroergotamine can be dangerous if it is used to treat headache in a person who has not been diagnosed by a doctor as having true migraine headaches.
Store at room temperature away from moisture, heat, and light. Do not use any stored dihydroergotamine if the expiration date on the label has passed.

What happens if I overdose on D.H.E. 45 (Dihydroergotamine)?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of dihydroergotamine can be fatal.
Overdose can cause stomach pain, nausea, vomiting, confusion, weak or shallow breathing, numbness and tingling or pain in your hands or feet, blue-colored fingers or toes, fainting, and seizure (convulsions).

What happens if I miss a dose of D.H.E. 45 (Dihydroergotamine)?

Since dihydroergotamine is used on an as-needed basis, you are not likely to miss a dose.
Do not use more than 3 injections of dihydroergotamine per day or more than 6 injections per week.
Sourced from everydayhealth.com

D.H.E. 45 Dihydroergotamine

D.H.E. 45 (Dihydroergotamine)