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Dihydroergotamine Mesylate
Dihydroergotamine Mesylate is a vasoconstrictor used to treat migraine headaches and cluster headaches. It belongs to the ergot alkaloid class of drugs, which work by narrowing blood vessels around the brain and reducing the abnormal expansion of these vessels during a migraine attack. It is typically used when other migraine medications, such as triptans, are ineffective or not tolerated.
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Frequently Asked Questions
How long does it take for Dihydroergotamine Mesylate to work?
The onset of relief typically begins within 30 minutes to 1 hour after administration for both the injectable and nasal spray forms.
Can I use Dihydroergotamine Mesylate daily?
No, this medication is intended for the acute treatment of migraine attacks. Daily use is not recommended, as it may lead to overuse headaches and increased side effects.
What should I do if I miss a dose?
Dihydroergotamine is used only during a migraine attack, so there is no need to worry about missed doses. Use the medication only as prescribed when symptoms begin.
Can I take Dihydroergotamine Mesylate with triptans?
No, you should avoid taking Dihydroergotamine within 24 hours of using any triptan medications, as this combination can increase the risk of serious cardiovascular complications.
Is Dihydroergotamine Mesylate safe during pregnancy?
No, Dihydroergotamine is contraindicated during pregnancy due to the risk of causing uterine contractions and harm to the fetus.
Comprehensive Drug Guide
How Does Dihydroergotamine Mesylate Work?
Dihydroergotamine works by stimulating serotonin receptors (5-HT receptors) in blood vessels, leading to the constriction of dilated blood vessels in the brain. This reduces the pulsating sensation and pain associated with migraine headaches. Additionally, it inhibits the release of certain neuropeptides that cause inflammation during migraines.
What is Dihydroergotamine Mesylate Used For?
- Acute treatment of migraine headaches
- Acute treatment of cluster headaches
Common Dosages
Dihydroergotamine Mesylate is available in the following forms:
- Injection: 1 mg/mL (used subcutaneously, intramuscularly, or intravenously)
- Nasal spray: 4 mg/ampule
Typical Dosing
FDA Approved Indications
- For acute migraine attacks, the typical dose is 1 mg injected subcutaneously or intramuscularly at the first sign of a headache, followed by a second dose of 1 mg one hour later if needed.
- For the nasal spray, one spray in each nostril (total of 2 mg) is used at the onset of the migraine, with a second dose after 15 minutes if required. The maximum dose is 3 mg per day.
Who Shouldn't Take Dihydroergotamine Mesylate?
Dihydroergotamine Mesylate should not be used in individuals with:
- Coronary artery disease or history of heart attack
- Uncontrolled hypertension
- Peripheral vascular disease
- Severe renal or hepatic impairment
- Pregnancy (due to the risk of uterine contractions)
- Concurrent use of CYP3A4 inhibitors (such as certain antifungals and antibiotics)
Advice From The Pharmacist
- Use Dihydroergotamine at the first sign of a migraine for the best results. It is not intended for preventive use but for acute relief.
- Avoid using more than the prescribed dose, as overuse can lead to rebound headaches or more serious side effects like ergotism (severe vasoconstriction leading to tissue damage).
- Do not use Dihydroergotamine if you are pregnant or planning to become pregnant. This medication can cause harm to the fetus.
- Store the medication at room temperature, away from light and moisture.
Side Effects of Dihydroergotamine Mesylate
Common Side Effects
- Nausea
- Vomiting
- Dizziness
- Flushing
- Nasal irritation (with nasal spray)
Uncommon/Severe Side Effects
- Chest pain or tightness
- Severe hypertension
- Numbness or tingling in the hands or feet
- Severe abdominal pain
- Leg weakness or pain (signs of peripheral vascular issues)
Risks and Warnings of Dihydroergotamine Mesylate
Cardiovascular Risk: Dihydroergotamine can cause significant vasoconstriction, leading to heart attack or stroke, especially in individuals with pre-existing cardiovascular conditions.
Ergotism: Overuse or misuse can result in ergotism, characterized by severe vasoconstriction, which can lead to gangrene and tissue damage.
Pregnancy Risk: This medication can cause uterine contractions, leading to miscarriage. It is contraindicated in pregnancy.
Interactions with Dihydroergotamine Mesylate
Common Drug Interactions
- CYP3A4 inhibitors: Combining Dihydroergotamine with drugs that inhibit the CYP3A4 enzyme, such as ketoconazole, clarithromycin, or ritonavir, can significantly increase the risk of serious vasoconstrictive reactions.
- Triptans: Taking triptans (e.g., sumatriptan) within 24 hours of using Dihydroergotamine can increase the risk of vascular complications.
- Beta-blockers: These drugs may increase the risk of peripheral ischemia when used with Dihydroergotamine.
Alternatives to Dihydroergotamine Mesylate
- Sumatriptan (Imitrex): A serotonin receptor agonist used for acute migraine treatment.
- Rizatriptan (Maxalt): A serotonin receptor agonist commonly used for migraines.
- Ergotamine tartrate: Another ergot alkaloid used for the treatment of migraines, although less commonly due to side effects.
- Lasmiditan (Reyvow): A newer migraine treatment targeting serotonin receptors.
- CGRP inhibitors (e.g., Aimovig): A newer class of medications used to prevent migraines.
