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D.H.E. 45
D.H.E. 45 is the brand name for dihydroergotamine, an ergot alkaloid medication prescribed primarily to treat migraine headaches with or without aura and cluster headaches. It belongs to a class of drugs known as ergot alkaloids, which work by narrowing the blood vessels in the brain to relieve migraine symptoms. Unlike typical pain relievers, D.H.E. 45 is specifically designed for acute headache treatment rather than for prevention.
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Frequently Asked Questions
How quickly does D.H.E. 45 work?
D.H.E. 45 typically begins to relieve migraine symptoms within 30 to 60 minutes of administration. Full relief may take up to two hours.
Can I take D.H.E. 45 with other migraine medications?
You should not take D.H.E. 45 with triptans or other vasoconstrictive agents within 24 hours due to the risk of severe vasoconstriction. Always consult your doctor before combining migraine treatments.
What should I do if I experience chest pain while using D.H.E. 45?
If you experience chest pain, tightness, or other signs of a heart problem, stop using D.H.E. 45 and seek immediate medical attention.
How often can I use D.H.E. 45?
You should not exceed 3 mg in a single day or 6 mg in a week. Using D.H.E. 45 more frequently may lead to medication overuse headaches or ergot toxicity.
Can D.H.E. 45 be used to prevent migraines?
No, D.H.E. 45 is not used as a preventive treatment. It is only for the acute relief of migraines and cluster headaches. Preventive medications such as beta-blockers or CGRP inhibitors may be prescribed for frequent migraines.
Comprehensive Drug Guide
How Does D.H.E. 45 Work?
D.H.E. 45 works by constricting blood vessels in the brain, counteracting the dilation believed to cause migraines. It binds to serotonin receptors, reducing inflammation and pain associated with acute headache attacks. This action helps stop migraines in progress but does not prevent future headaches.
What is D.H.E. 45 Used For?
- Acute treatment of migraine headaches, with or without aura
- Acute treatment of cluster headaches
Common Dosages
D.H.E. 45 is available by prescription in the form of injections or nasal sprays. It is not classified as a controlled substance, but it should only be used under a doctor’s supervision due to its specific actions on blood vessels. Availability may vary, but it is generally accessible through pharmacies and medical providers who treat headaches.
- Injection: 1 mg/mL solution
- Nasal Spray: 4 mg in a spray bottle
- These forms are designed for rapid relief of headache symptoms.
Typical Dosing
FDA Approved Indications
For adults, the usual dose is 1 mg via injection, with a second dose 1 hour later if needed, up to a maximum of 3 mg per 24 hours. For nasal spray, 0.5 mg in each nostril can be repeated every 15 minutes, up to a total of 2 mg.
Off-Label Uses
- Off-label Uses: Sometimes used for refractory migraines that do not respond to other treatments.
Who Shouldn't Take D.H.E. 45?
- Peripheral vascular disease
- Uncontrolled hypertension
- Severe liver or kidney disease
- Known hypersensitivity to dihydroergotamine or other ergot alkaloids
- Pregnancy (D.H.E. 45 is contraindicated due to the risk of uterine contractions)
Advice From The Pharmacist
- Administer D.H.E. 45 as soon as you feel the first signs of a migraine for the best results. It is less effective if taken once the migraine is fully established.
- Do not exceed the maximum recommended dose of 3 mg per day or 6 mg per week to avoid the risk of severe side effects, such as ergot toxicity.
- Avoid using other vasoconstrictive agents, such as triptans, within 24 hours of taking D.H.E. 45.
- Store the injectable solution at room temperature and keep it away from light.
Side Effects of D.H.E. 45
Common Side Effects
- Nausea
- Vomiting
- Dizziness
- Diarrhea
- Muscle pain
Uncommon/Severe Side Effects
- Chest pain or tightness
- Numbness or tingling in the extremities
- Severe headache or vision changes
- Signs of an allergic reaction (e.g., rash, difficulty breathing)
Risks and Warnings of D.H.E. 45
Cardiovascular Risk: D.H.E. 45 can cause severe vasoconstriction, which may lead to heart attacks, strokes, or other cardiovascular issues, especially in patients with underlying heart conditions or risk factors for vascular disease.
Ergotism: High doses or prolonged use of ergot alkaloids can lead to a condition called ergotism, characterized by severe vasoconstriction, numbness, and gangrene.
Medication Overuse Headaches: Frequent use of D.H.E. 45 for migraine treatment can lead to rebound headaches. It should not be used more than the recommended dosage.
Interactions with D.H.E. 45
Common Drug Interactions
- Triptans: Concurrent use of triptans (e.g., sumatriptan) with D.H.E. 45 can lead to severe vasoconstriction and should be avoided.
- Protease inhibitors (e.g., ritonavir): These can increase the risk of ergot toxicity when taken with D.H.E. 45.
- CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): These drugs can increase the levels of dihydroergotamine in the body and raise the risk of adverse effects.
Alternatives to D.H.E. 45
- Triptans (e.g., sumatriptan, rizatriptan): These are commonly used first-line treatments for acute migraines.
- Beta-blockers: Used as a preventive treatment for migraines.
- CGRP inhibitors (e.g., erenumab): A newer class of migraine prevention medications.
- NSAIDs: Nonsteroidal anti-inflammatory drugs may be used for mild to moderate migraines.
