Dihydroergotamine mesylate
Dihydroergotamine mesylate (D.H.E. 45)
Dihydroergotamine mesylate
(dye-hy-droh-er- GOT-ah-meen)
Pregnancy Category: X D.H.E. 45 Dihydroergotamine (DHE) Sandoz Migranal Nasal Spray (Rx)

Classification: Alpha-adrenergic blocking agent

Action/Kinetics: Manifests alpha-adrenergic receptor blocking activity as well as a direct stimulatory action on vascular smooth muscle of peripheral and cranial blood vessels, resulting in vasoconstriction, thus preventing the onset of a migraine attack. Manifests greater adrenergic blocking activity, less pronounced vasoconstriction, less N&V;, and less oxytocic properties than does ergotamine. More effective when given early in the course of a migraine attack. Onset: IM, 15-30 min; IV, <5 min. Duration: IM, 3-4 hr. t 1/2: initial, 1.4 hr; final, 18-22 hr. Metabolized in liver and excreted in feces with less than 10% excreted through the urine.

Uses: IM, IV. To prevent or abort migraine, migraine variant, histaminic cephalalgia (cluster headaches). Especially useful when rapid effect is desired or when other routes of administration are not possible. Nasal Spray. Acute treatment of migraine headaches with or without aura.

Contraindications: Lactation. Pregnancy. Peripheral vascular disease, coronary heart disease, hypertension, impaired hepatic or renal function, sepsis, hypersensitivity, malnutrition, severe pruritus, presence of infection.

Special Concerns: Safety and efficacy have not been determined in children. Geriatric clients may be more affected by peripheral vasoconstriction that results in hypothermia. Prolonged administration may cause ergotism and gangrene.

Side Effects: CV: Precordial pain, transient tachycardia or bradycardia. Large doses may cause increased BP, vasoconstriction of coronary arteries, and bradycardia. GI: N&V;, diarrhea. Other: Numbness and tingling of fingers and toes, muscle pain in extremities, weakness in legs, localized edema, and itching. Prolonged use: Gangrene, ergotism.

Overdose Management: Symptoms: N&V;, pain in limb muscles, tachycardia or bradycardia, precordial pain, numbness and tingling of fingers and toes, weakness of the legs, hypertension or hypotension, localized edema, S&S; of ischemia due to vasoconstriction of peripheral arteries and arterioles. Symptoms of ischemia include the feet and hands becoming cold, pale, and numb; muscle pain, gangrene. Occasionally confusion, depression, drowsiness, and seizures. Treatment: Maintain adequate circulation. IV nitroglycerin and nitroprusside to treat vasospasm. IV heparin and low molecular weight dextran to minimize thrombosis.

Drug Interactions: Beta-adrenergic blockers / Peripheral ischemia resulting in cold extremities and possibly peripheral gangrene Macrolide antibiotics / Acute ergotism resulting in peripheral ischemia Nitrates / Bioavailability of hydroergotamine and anginal effects of nitrates

How Supplied: Injection: 1 mg/mL; Nasal Spray: 0.5 mg/inh

Dosage
?IM Suppress vascular headache.
Adults, initial: 1 mg at first sign of headache; repeat q hr for a total of 3 mg (not to exceed 6 mg/week).
?IV Suppress vascular headache.
Similar to IM but to a maximum of 2 mg/attack or 6 mg/week.
?Nasal spray Acute migraine headaches.
Single treatment of 0.5 mg spray in each nostril followed in 15 min by a second 0.5 mg spray in each nostil (i.e., total of 2 mg).