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NERVOUS SYSTEM › ANALGESICS › ANTIMIGRAINE PREPARATIONS › Ergot alkaloids
dihydroergotamine, combinations
N02CA51
Forms & Strengths
- Dihydroergotamine mesylate 1 mg/mL injection
- Dihydroergotamine mesylate 4 mg/mL nasal spray
Adult Dosing
- Intranasal: 2 mg (one spray of 0.5 mg in each nostril, repeated in 15 minutes for a total dose of 2 mg)
- Intravenous / Intramuscular / Subcutaneous: 1 mg at start of attack; may repeat hourly to max 2 mg (IV) or 3 mg (IM/SC) per day
- Maximum weekly dose: 6 mg (IV) or 6 mg (IM/SC)
Pediatric Dosing
- Safety and efficacy not established in pediatric patients under 18 years of age
Indications
- Acute treatment of migraine headaches with or without aura
- Acute treatment of cluster headache episodes
Mechanism of Action
- Agonist effect on 5-hydroxytryptamine (5-HT1D and 5-HT1B) receptors, causing vasoconstriction of intracranial blood vessels
- Inhibition of pro-inflammatory neuropeptide release from trigeminal nerve endings
Contraindications
- Ischemic heart disease, history of myocardial infarction, or Prinzmetal's angina
- Uncontrolled hypertension
- Hemiplegic or basilar migraine
- Peripheral vascular disease and severe hepatic or renal impairment
- Concurrent administration of potent CYP3A4 inhibitors (e.g., protease inhibitors, macrolide antibiotics)
- Concurrent use of other 5-HT1 receptor agonists or ergotamine-containing products within 24 hours
- Pregnancy and lactation
Adverse Reactions
- Nausea and vomiting
- Dizziness and fatigue
- Paresthesias and flushing
- Rhinitis and throat irritation (nasal spray)
- Vasospasm, chest tightness, and myocardial ischemia (rare)
Drug Interactions
- Potent CYP3A4 inhibitors (e.g., ritonavir, ketoconazole, erythromycin) increase risk of vasospasm and ischemia
- Vasoconstrictors and other triptans increase risk of additive vasospastic effects; avoid within 24 hours
- Nicotine and tobacco products may provoke vasoconstriction
Curated Content: Needs Vetting Before Put to Clinical Use