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All about: D.H.E. 45

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Generic Name: dihydroergotamine (dye hye droe er GOH ta meen)
Brand Names: D.H.E. 45, Migranal

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

Dihydroergotamine affects vasoconstriction (narrowing of arteries and veins). Dihydroergotamine also affects blood flow patterns that are associated with vascular headaches.

Dihydroergotamine is used to prevent and to treat vascular headaches such as migraine and cluster headaches.

Dihydroergotamine may also be used for purposes other than those listed in this medication guide.

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

Some medications may increase the risk of dangerously decreased blood flow to the brain, heart, or extremities when taken with dihydroergotamine. In rare but severe cases, gangrene or other serious problems can result. Some, but not all, of these medications are listed below in the section "What other drugs will affect dihydroergotamine?". Do not take any other medications during treatment with dihydroergotamine without first talking to your doctor.

Notify your doctor immediately if you experience an irregular heartbeat; nausea; vomiting; weakness; or coldness, numbness, or pain in the hands, feet, arms, or legs.

Do not use more of this medication than is prescribed for you. If your symptoms are not being adequately treated, contact your doctor.

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

Some medications may increase the risk of dangerously decreased blood flow to the brain, heart, or extremities when taken with dihydroergotamine. In rare but severe cases, gangrene or other serious problems can result. Some, but not all, of these medications are listed below in the section "What other drugs will affect dihydroergotamine?". Do not take any other medications during treatment with dihydroergotamine without first talking to your doctor. Do not use dihydroergotamine without first talking to your doctor if you have
  • peripheral vascular disease or poor circulation;

  • arteriosclerosis or "hardening of the arteries";

  • high blood pressure,

  • heart disease (angina, history of heart attack, silent ischemia);

  • liver disease;
  • kidney disease; or
  • a serious infection.

You may not be able to use dihydroergotamine, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

Dihydroergotamine is in the FDA pregnancy category X. This means that it is known to be very harmful if used during pregnancy. Dihydroergotamine can induce uterine contractions, and it can restrict blood flow to the fetus. Do not use dihydroergotamine if your are pregnant or could become pregnant during treatment. 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.

How should I use D.H.E. 45 (dihydroergotamine)?

Use dihydroergotamine exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Use the first dose of dihydroergotamine at the first sign of a headache.

For the injectable form of dihydroergotamine, inject up to 1 mg (1 mL) as directed at the first sign of a headache. Two additional doses can be given at 1 hour intervals up to a total of 3 mg (3 mL). Doses smaller than 3 mg may be effective.

Do not use more than 3 mg in any 24-hour period. Do not use more than 6 mg in any 7 days. If your symptoms are not being adequately treated, see your doctor.

Store dihydroergotamine at room temperature away from moisture and heat.

What happens if I miss a dose?

Since dihydroergotamine is used on an as-needed basis, missing a dose is not usually a problem.

What happens if I overdose?

Seek emergency medical attention.

Symptoms of a dihydroergotamine overdose include nausea, vomiting, weakness, muscle pain, numbness in your fingers or toes, gangrene, itching, confusion, drowsiness, convulsions, and possibly death.

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

Do not use more of this medication than is prescribed for you. If your symptoms are not being adequately treated, see your doctor.

D.H.E. 45 (dihydroergotamine) side effects

Stop taking dihydroergotamine and seek emergency medical attention or contact your doctor immediately if you experience.
  • an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);

  • chest pain;

  • numbness or tingling in the fingers or toes;

  • muscle pain in the arms or legs;

  • leg weakness;

  • changes in heart rate;

  • swelling; or

  • itching.

Other, less serious side effects may also occur. Continue to take dihydroergotamine and talk to your doctor if you experience nausea or vomiting.

Dihydroergotamine may be habit forming when used for long periods of time. Larger doses may be needed for headache relief, and withdrawal effects may occur when ergotamine therapy is stopped.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

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

Some medications may increase the risk of dangerously decreased blood flow to the brain, heart, or extremities when taken with dihydroergotamine. In rare but severe cases, gangrene or other serious problems can result. The following drugs should not be taken with dihydroergotamine or should be used only under the close supervision of a doctor:
  • another medication that contains an ergot compound such as Ergomar, D.H.E., or D.H.E. Nasal;

  • another migraine headache medicine such as almotriptan (Axert), sumatriptan (Imitrex), zolmitriptan (Zomig), rizatriptan (Maxalt), or naratriptan (Amerge)--these medicines must not be taken within 24 hours of a dose of dihydroergotamine;

  • a selective serotonin reuptake inhibitor (SSRI) such as citalopram (Celexa), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), sertraline (Zoloft), or paroxetine (Paxil);

  • a beta-blocker (which are used to treat high blood pressure, irregular heartbeats, and other heart conditions) such as carteolol (Cartrol), carvedilol (Coreg), labetalol (Normodyne, Trandate), nadolol (Corgard), pindolol (Visken), propranolol (Inderal), sotalol (Betapace), or timolol (Blocadren);

  • an HIV/AIDS medicine such as amprenavir (Agenerase), delavirdine (Rescriptor), indinavir (Crixivan), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Norvir), or saquinavir (Invirase, Fortovase);

  • the antibiotics erythromycin (Ery-Tab, E.E.S., E-Mycin, Eryc, others) or clarithromycin (Biaxin);

  • the antifungals medicines itraconazole (Sporanox) or ketoconazole (Nizoral);

  • nefazodone (Serzone);

  • cimetidine (Tagamet, Tagamet HB); or

  • sibutramine (Meridia).

Drugs other than those listed here may also interact with dihydroergotamine. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.

Where can I get more information?

  • Your pharmacist has more information about dihydroergotamine written for health professionals that you may read.

What does my medication look like?

Dihydroergotamine is available with a prescription under the brand name D.H.E. in 1 mg per 1 mL ampules for injection. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Copyright 1996-2006 Cerner Multum, Inc. Version: 3.04. Revision Date: 2/13/04 3:59:07 PM.

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