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What is the most important information I should know about 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.

Warning

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.

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What is 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 ususal migraine headaches.

Dihydroergotamine injection may also be used for other purposes not listed in this medication guide.

Precautions

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.

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.

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Instructions

Seek emergency medical attention if you think you have used too much of this medicine. 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).

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.

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Side Effects

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.

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Interactions

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:

  • 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 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.

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Disclaimer

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 1996-2004 Cerner Multum, Inc. Version 2.05. Revision date 8/23/04