DihydroergotamineDihydroergotamine Mesylate

About Dihydroergotamine

DHE acts on the serotonin receptors that triptans target, narrowing dilated blood vessels and calming the nerve signals behind an attack. It treats attacks once started and is not for prevention or daily use. Generic vials, given into a vein, a muscle or under the skin, and the Brekiya autoinjector, used under the skin, are approved for migraine and cluster headache; the nasal products, each with its own device and dose, are for migraine only.

Its boxed warning covers strong CYP3A4 inhibitors: HIV protease inhibitors, clarithromycin, erythromycin, ketoconazole and itraconazole raise DHE levels and can narrow blood vessels enough to cut off blood flow to the brain or limbs, so these combinations are contraindicated. DHE is also not used with coronary artery disease, uncontrolled high blood pressure, peripheral artery disease, sepsis, after vascular surgery, with severe liver or kidney disease, or in hemiplegic or basilar migraine, and it is avoided in pregnancy because it can cause preterm labor.

The sprays commonly cause a stuffy or irritated nose, altered taste, nausea and dizziness. Prolonged daily use of the injection has been linked to fibrosis around the lungs and behind the abdomen, and overuse can cause medication-overuse headache.

Taking Dihydroergotamine

How to take it

Use it when a migraine starts, following your product’s instructions. For the Migranal-type spray, prime the assembled sprayer by pumping 4 times, give one spray in each nostril, and repeat 15 minutes later, without tilting your head back or sniffing. An injection is 1 mg, repeatable at 1-hour intervals up to the daily limit.

If you miss a dose

It is used only when needed. Do not exceed the daily or weekly limit for your product.

Storage

Vials and the Migranal-type spray at room temperature, not refrigerated or frozen, with vials in the carton away from light. An opened vial unused after an hour is thrown away, as is an opened nasal spray vial after 8 hours.

Interactions to know about

Strong CYP3A4 inhibitors must not be combined with it, and weaker ones such as fluconazole, fluoxetine, fluvoxamine, nefazodone, zileuton, clotrimazole and grapefruit juice need caution. It is not used within 24 hours of a triptan or another ergot, or with other drugs that narrow blood vessels. Seek urgent care for chest pain, severe stomach pain, or numbness, tingling or color change in the fingers or toes.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Dihydroergotamine differs from pharmacy to pharmacy

Each form is a separate product. Generic vials and the generic spray have several makers but are not everyday items, so a pharmacy may need to order them; the spray is sold as a kit of eight single-use vials with sprayers. Trudhesa, Atzumi and Brekiya are brand-only, so every pharmacy pays a brand price and quotes differ mainly by mark-up.

Ways to pay less for Dihydroergotamine without insurance

• If a brand-only nasal product is prescribed, ask whether the generic Migranal-type spray would suit you; switching needs a new prescription.
• If Brekiya is prescribed, ask whether generic vials would be suitable; the dose is the same 1 mg.
• For brand-only products, ask the manufacturer about patient assistance.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Dihydroergotamine

1. 1.Do any of my medicines, including antibiotics, antifungals or HIV drugs, interact with DHE?
2. 2.How do I assemble and prime the nasal spray?
3. 3.What is my limit per day and per week?
4. 4.Which form is this, and is a generic available?

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