Dihydroergotamine injection

What is dihydroergotamine injection?

DIHYDROERGOTAMINE (D.H.E. 45®) is a medicine known as an ergot alkaloid. Dihydroergotamine helps to treat certain kinds of migraine and cluster headaches. This medication should only be used as soon as you know a headache is starting, to help stop the acute attack. Generic dihydroergotamine injections are available.

What should my health care professional know before I receive dihydroergotamine?

They need to know if you have any of these conditions:

• chest pain or difficulty breathing

• heart or blood vessel disease, or any surgery on your heart arteries

• high blood pressure

• kidney or liver disease

• problems with blood circulation in your arms or legs, fingers, or toes

• risk factors for heart disease such as smoking, high cholesterol, a family history of heart disease, or if you are postmenopausal or a male over 40 years of age

• an unusual or allergic reaction to dihydroergotamine, ergot alkaloids, other medicines, foods, dyes, or preservatives

• pregnant or trying to get pregnant

• breast-feeding

How should I use this medicine?

Dihydroergotamine is for injection into a vein, into a muscle, or under the skin. This drug is usually given in a hospital or clinic setting and a health care provider will give you the injection. This drug is not for daily use. Do not use this medicine more often than directed.

Contact your pediatrician or health care professional regarding the use of this medicine in children. Special care may be needed.

What if I miss a dose?

This does not apply since you will only receive a dihydroergotamine injection when you actually have a headache. Do not use double or extra doses. Do not exceed the daily or weekly dosage limits. Ask your prescriber if you are uncertain what these limits are.

What drug(s) may interact with dihydroergotamine?

Do not use any of the following migraine drugs within 24 hours of this medicine: almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, or zolmitriptan. Also, do not use this drug with caffeine-ergotamine (examples: Cafergot®, Wigraine®); ergotamine (example: Ergomar®); methysergide (Sansert®); ergonovine; or methylergonovine (Methergine®).

Dihydroergotamine may also interact with:

• antibiotics such as erythromycin, clarithromycin, and troleandomycin

• antifungal drugs like fluconazole, itraconazole, ketoconazole or voriconazole

• aprepitant

• bromocriptine

• cabergoline

• cocaine

• danazol

• ergoloid mesylates (Hydergine®)

• herbal products like feverfew or guarana

• fluoxetine

• fluvoxamine

• grapefruit juice

• imatinib, STI-571

• medicines for colds, flu, or breathing difficulties

• medicines for high blood pressure

• medicines or herbal products to decrease weight or appetite

• metronidazole

• nefazodone

• nicotine

• some medications for the treatment of HIV infection or AIDS

• zileuton

Tell your prescriber or health care professional about all other medicines you are taking, including nonprescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

What should I watch for while taking dihydroergotamine?

Check with your prescriber or health care professional if you get more frequent or severe headaches after you start using dihydroergotamine. Tell your prescriber or health care professional if dihydroergotamine gets less effective; do not use more dihydroergotamine.

Dihydroergotamine works best when you take it at the first sign of headache pain. Lie down in a quiet, dark room after a dose until you feel better.

Alcohol can make headaches worse or bring on a new headache. Avoid alcoholic drinks. Smoking can increase side effects of dihydroergotamine; avoid smoking.

Dihydroergotamine decreases the circulation of blood to your skin, fingers, and toes. You may get more sensitive to the cold. Elderly patients are more likely to feel this effect. Dress warmly and avoid long exposure to the cold.

If you are going to have any type of surgery, tell your prescriber or health care professional that you are taking dihydroergotamine.

What side effects may I notice from receiving dihydroergotamine?

Side effects that you should report to your prescriber or health care professional as soon as possible:

• blisters on hands or feet

• muscle pain or cramps

• pain, tightness, or discomfort in your chest

• pain, redness, swelling or irritation at the injection site

• palpitations or changes in heart rate

• swelling or itching

• tingling, pain or numbness in the fingers or toes

• weakness in legs

• vomiting

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):

• changes in the taste of food

• cold hands or feet

• mild dizziness or drowsiness

• nasal congestion or irritation

• nausea

• sore throat or throat irritation

Where can I keep my medicine?

Keep out of the reach of children.

Store at room temperature below 25 degrees C (77 degrees F). Protect from light, moisture, and heat. Do not refrigerate or freeze. Only use if clear and colorless. Throw away any unused medicine after the expiration date.

Dihydroergotamine nasal spray

What is dihydroergotamine nasal spray?

DIHYDROERGOTAMINE (Migranal®) is a medicine known as an ergot alkaloid. Dihydroergotamine helps to treat certain kinds of migraine and cluster headaches. This medication should only be used as soon as you know a headache is starting, to help stop the acute attack. Generic dihydroergotamine nasal spray is not yet available.

What should my health care professional know before I use dihydroergotamine?

They need to know if you have any of these conditions:

• chest pain or difficulty breathing

• heart or blood vessel disease, or any surgery on your heart arteries

• high blood pressure

• kidney or liver disease

• problems with blood circulation in your arms or legs, fingers, or toes

• risk factors for heart disease such as smoking, high cholesterol, a family history of heart disease, or if you are postmenopausal or a male over 40 years of age

• an unusual or allergic reaction to dihydroergotamine, ergot alkaloids, other medicines, foods, dyes, or preservatives

• pregnant or trying to get pregnant

• breast-feeding

How should I use this medicine?

You must prepare the nasal spray only when you are ready to use it (at the first sign of migraine headache pain). Follow the directions on the prescription label. This drug is not for daily use. Do not use this medicine more often than directed.

To prepare the nasal spray, first read the directions that are provided with your medicine. 1) tap the top of the brown glass container (ampule) until all the medication is in the bottom, 2) place the ampule upright and straight in the well of the assembly case with the breaker cap pointing up, 3) push down the assembly case lid slowly but firmly until you hear the ampule snap open, 4) without removing the ampule from the well, push the nasal sprayer onto the ampule until it clicks (to make sure the ampule fits properly into the nasal sprayer, look at the tube through the bottom of the sprayer to make sure it is straight. If it is curved, straighten it with your finger).

To use the nasal spray, remove the cover. Pump the spray 4 times before using (point the spray up and away from your face when pumping). Do not prime the pump more than 4 times. Although some medication will spray out, there is enough medication in each ampule for you to still receive a full dose. After priming, spray once in each nostril. Do not tilt your head back or sniff (inhale) through your nose while spraying. Wait 15 minutes, then spray once in each nostril again. Each ampule contains one complete dose (4 sprays). Do not use more than 4 total sprays to treat a migraine headache.

After using your spray, throw the sprayer away (each sprayer is only good for 8 hours). Load a new tray containing an unopened ampule and nasal sprayer into your assembly case. Keep the assembly case for a total of 4 treatments, then throw it away along with the tray.

Contact your pediatrician or health care professional regarding the use of this medicine in children. Special care may be needed.

What if I miss a dose?

This does not apply since you only take dihydroergotamine when you actually have a headache. Do not use double or extra doses. Do not exceed the daily or weekly dosage limits on the label. Ask your prescriber if you are uncertain what these limits are.

What drug(s) may interact with dihydroergotamine?

Do not use any of the following migraine drugs within 24 hours of this medicine: almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, or zolmitriptan. Also, do not use this drug with caffeine-ergotamine (examples: Cafergot®, Wigraine®); ergotamine (example: Ergomar®); methysergide (Sansert®); ergonovine; or methylergonovine (Methergine®).

Dihydroergotamine may also interact with:

• antibiotics such as erythromycin, clarithromycin, and troleandomycin

• antifungal drugs like fluconazole, itraconazole, ketoconazole or voriconazole

• aprepitant

• bromocriptine

• cabergoline

• cocaine

• danazol

• ergoloid mesylates (Hydergine®)

• herbal products like feverfew or guarana

• fluoxetine

• fluvoxamine

• grapefruit juice

• imatinib, STI-571

• medicines for colds, flu, or breathing difficulties

• medicines for high blood pressure

• medicines or herbal products to decrease weight or appetite

• metronidazole

• nefazodone

• nicotine

• some medications for the treatment of HIV infection or AIDS

• zileuton

Tell your prescriber or health care professional about all other medicines you are taking, including nonprescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

What should I watch for while taking dihydroergotamine?

Check with your prescriber or health care professional if you get more frequent or severe headaches after you start using dihydroergotamine. Tell your prescriber or health care professional if dihydroergotamine gets less effective. Do not use more dihydroergotamine than your prescriber or health care professional has prescribed.

Dihydroergotamine works best when you take it at the first sign of headache pain. Lie down in a quiet, dark room after a dose until you feel better.

Alcohol can make headaches worse or bring on a new headache. Avoid alcoholic drinks. Smoking can increase side effects of dihydroergotamine; avoid smoking.

Dihydroergotamine decreases the circulation of blood to your skin, fingers, and toes. You may get more sensitive to the cold. Elderly patients are more likely to feel this effect. Dress warmly and avoid long exposure to the cold.

If you are going to have any type of surgery, tell your prescriber or health care professional that you are taking dihydroergotamine.

What side effects may I notice from receiving dihydroergotamine?

Side effects that you should report to your prescriber or health care professional as soon as possible:

• blisters on hands or feet

• muscle pain or cramps

• pain, tightness, or discomfort in your chest

• palpitations or changes in heart rate

• swelling or itching

• tingling, pain or numbness in the fingers or toes

• weakness in legs

• vomiting

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):

• changes in the taste of food

• cold hands or feet

• mild dizziness or drowsiness

• nasal congestion or sore throat

• nausea

Where can I keep my medicine?

Keep out of the reach of children.

Store at room temperature below 25 degrees C (77 degrees F). Protect from light, moisture, and heat. Do not refrigerate or freeze. Keep the parts of the nasal spray in the tray provided. Keep this tray loaded in the assembly case. Do not keep an opened nasal spray for more than 8 hours. Discard any unopened medicine after the expiration date.