Dihydroergotamine (nasal)
Generic name: dihydroergotamine (nasal) [ dye-HYE-droe-er-GOT-a-meen ]
Brand names: Migranal, Trudhesa
Dosage form: nasal spray (4 mg/mL)
Drug class: Antimigraine agents
What is dihydroergotamine nasal?
Dihydroergotamine nasal is used to treat migraine headaches with or without aura in adults. Dihydroergotamine nasal will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks.
Dihydroergotamine nasal should not be used to treat common tension headaches or any headache that seems to be different from your usual migraine headaches.
Dihydroergotamine nasal may also be used for purposes not listed in this medication guide.
Warnings
Tell your doctor about all your other medicines. Some drugs should not be used with dihydroergotamine.
Before taking this medicine
You should not use dihydroergotamine if you are allergic to it or similar medicines (ergotamine, ergonovine, methylergonovine, and others), or if you have:
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heart disease, angina (chest pain), blood circulation problems, coronary artery disease (hardening of the arteries), or history of a heart attack or stroke;
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uncontrolled high blood pressure;
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severe liver or kidney disease;
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if you have had vascular surgery.
Some drugs should not be used with dihydroergotamine. Your treatment plan may change if you also use:
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an antibiotic such as clarithromycin or erythromycin;
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antifungal medicine such as itraconazole or ketoconazole; or
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antiviral medicine for HIV or hepatitis C.
Tell your doctor if you have ever had:
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blood circulation problems in your arms, hands, legs, or feet;
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chest pain, shortness of breath;
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liver or kidney disease; or
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risk factors for coronary artery disease (high blood pressure, high cholesterol, diabetes, menopause, smoking, family history of coronary artery disease, being overweight, being over 40 and a man).
Dihydroergotamine can affect blood circulation to your uterus. Tell your doctor if you are pregnant or plan to become pregnant. Do not use dihydroergotamine if you are pregnant.
Do not breastfeed while using this medicine, and for at least 3 days after your last dose. Talk with your doctor about the best way to feed your baby.
How should I use dihydroergotamine nasal?
Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.
Dihydroergotamine nasal spray is absorbed quickly through your nasal passages and is for use only in the nose. The nasal spray liquid should not be injected into the body.
Your doctor may want to give your first dose of this medicine in a medical setting to quickly treat any serious side effects that occur.
You may need medical tests to check your heart function.
Store at room temperature away from moisture and heat. Do not keep this medicine in a refrigerator or freezer.
A Trudhesa vial should be thrown away 8 hours after it has been opened.
What happens if I miss a dose?
Dihydroergotamine is used when needed. If you are on a dosing schedule, skip any missed dose. Do not use two doses at one time.
Do not use more than 2 doses of Trudhesa within 24 hours or 3 doses within 7 days.
Do not use more than 3 mg of Migranal within 24 hours or 4 mg within 7 days.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of dihydroergotamine. An overdose can be fatal.
What should I avoid while using dihydroergotamine nasal?
Do not use dihydroergotamine nasal within 24 hours before or after using another migraine headache medicine, including:
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another ergot medicine such as ergotamine, ergonovine, methylergonovine; or
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almotriptan, eletriptan, frovatriptan, naratriptan, sumatriptan, or rizatriptan.
Grapefruit may interact with dihydroergotamine nasal and cause side effects. Avoid consuming grapefruit products.
Dihydroergotamine nasal side effects
Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Dihydroergotamine may cause serious side effects. Call your doctor at once if you have:
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signs of a blood clot--sudden numbness or weakness on one side of the body, problems with vision or speech, pain or swelling in one leg;
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stomach cramps, diarrhea that may be bloody;
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numbness or tingling in your fingers or toes;
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chest pain or tightness, shortness of breath;
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muscle pain in your arms or legs;
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leg weakness; or
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swelling or itching.
Common side effects of dihydroergotamine may include:
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pain, bruising, swelling, or irritation where the medicine was applied;
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sleep problems (insomnia);
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altered sense of taste; or
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soreness or irritation in your nose.
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.
Dihydroergotamine dosing information
Usual Adult Dose for Migraine:
Parenteral:
Initial dose: 1 mg IM/IV/subcutaneously
-Additional 1 mg dose may be given at hourly intervals as needed not to exceed daily maximums
Maximum doses:
-IV: 2 mg/24 hours; 6 mg/7-day period
-IM/subcutaneously: 3 mg/ 24 hours; 6 mg/ 7-day period
Nasal Spray:
Initial dose: 0.5 mg (1 spray) intranasally into both nostrils; repeat in 15 minutes
Total dose: 2 mg (2 sprays in each nostril 15 minutes apart)
-Acute doses greater than 2 mg have not been shown to provide additional benefits
Maximum doses: 3 mg/24 hours; 4 mg/7-day period
Comments:
-This drug should only be used where a clear diagnosis of migraine headache has been established.
-This drug is not intended for chronic daily administration.
Use: For the acute treatment of migraine headaches with or without aura.
Usual Adult Dose for Cluster Headache:
Initial dose: 1 mg IM/IV/subcutaneously
-Additional 1 mg dose may be given at hourly intervals as needed not to exceed daily maximums
Maximum doses:
-IV: 2 mg/24 hours; 6 mg/7-day period
-IM/subcutaneously: 2 mg/ 24 hours; 6 mg/ 7-day period
Comments:
-This drug is not intended for chronic daily administration.
Use: For the acute treatment of cluster headache episodes.
What other drugs will affect dihydroergotamine nasal?
Tell your doctor about all your current medicines. Many drugs can affect dihydroergotamine, especially:
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heart or blood pressure medication;
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nicotine gum or patches;
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an antidepressant; or
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medicine to treat an infection.
This list is not complete. Many drugs can affect dihydroergotamine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all other medicines you use.
Where can I get more information?
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.
Frequently asked questions
More about dihydroergotamine
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- Drug class: antimigraine agents
- Breastfeeding
Patient resources
- Drug Information
- Dihydroergotamine Injection (Advanced Reading)
- Dihydroergotamine Nasal (Advanced Reading)
- Dihydroergotamine Nasal Spray
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