Generic Name: dihydroergotamine (injection) (dye HYE droe er GOT a meen)Brand Names: D.H.E. 45
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 other purposes not listed in this medication guide.What is the most important information I should know about D.H.E. 45 (dihydroergotamine (injection))?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 using D.H.E. 45 (dihydroergotamine (injection))?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;
a serious infection called sepsis; or
if you have recently had heart or blood vessel surgery (such as bypass surgery).
diclofenac (Arthrotec, Cataflam, Voltaren, Flector Patch, Solareze);
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:
high blood pressure;
ischemic bowel 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).
Use this medication 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 injection is given as a shot into a muscle or under the skin. Your doctor, nurse, or other healthcare provider will show you how to inject your medicine 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 dihydroergotamine at room temperature away from moisture, heat, and light. Do not use any stored dihydroergotamine if the expiration date on the label has passed.
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.
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).
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.
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;
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;
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.
Many drugs can interact with dihydroergotamine. Below is just a partial list. Talk with your doctor before using dihydroergotamine injection if you are also taking:
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 there may be other drugs that can interact with dihydroergotamine. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.