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Trudhesa
Trudhesa (generic name: dihydroergotamine mesylate) is a prescription nasal spray used to treat acute migraine headaches with or without aura in adults. It is part of a class of medications known as ergot alkaloids, which work by narrowing the blood vessels around the brain, helping to alleviate migraine symptoms such as throbbing headache, nausea, and sensitivity to light and sound. Trudhesa is typically used when other migraine treatments, such as triptans, are ineffective or not tolerated.
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Frequently Asked Questions
How quickly does Trudhesa work?
Trudhesa typically begins working within 15 to 30 minutes after administration. It is intended for fast relief of acute migraine symptoms.
Can I use Trudhesa to prevent migraines?
No, Trudhesa is not intended for the prevention of migraines. It is only used for the acute treatment of migraine attacks as they occur.
Can I use Trudhesa if I have heart problems?
Trudhesa should not be used if you have a history of heart disease, angina, or uncontrolled high blood pressure. Always inform your healthcare provider of any cardiovascular conditions before using this medication.
What should I do if I miss a dose?
Trudhesa is used as needed during a migraine attack. There is no regular dosing schedule, so simply take it as directed when a migraine begins.
Is Trudhesa safe during pregnancy?
No, Trudhesa is contraindicated during pregnancy due to the risk of uterine contractions and fetal harm.
Comprehensive Drug Guide
How Does Trudhesa Work?
Trudhesa works by binding to serotonin (5-HT) receptors and other receptors in the brain. This action causes the constriction of dilated blood vessels, which is thought to play a key role in migraine headache relief. Additionally, dihydroergotamine inhibits the release of pro-inflammatory neuropeptides, which helps to reduce the symptoms of a migraine.
Common Dosages
- Each spray of Trudhesa delivers 0.725 mg of dihydroergotamine mesylate. The recommended dose is one spray per nostril during a migraine attack.
Typical Dosing
- Administer one spray into each nostril (total dose: 1.45 mg) at the onset of a migraine attack.
- Do not exceed more than 2 doses (4 sprays) in a 24-hour period or more than 3 doses in a week.
- Trudhesa is used as needed for acute migraine attacks, and it is not intended for the prevention of migraines.
Typical Dosing
FDA Approved Indications
- Acute treatment of migraine with or without aura in adults.
Who Shouldn't Take Trudhesa?
- History of coronary artery disease, angina, or heart attack.
- Uncontrolled hypertension.
- Peripheral vascular disease.
- Severe liver or kidney disease.
- History of stroke or transient ischemic attack (TIA).
- Pregnancy (due to the risk of uterine contractions and fetal harm).
- Concurrent use of CYP3A4 inhibitors (such as certain antifungals or macrolide antibiotics), as this can increase the risk of serious side effects.
Advice From The Pharmacist
- Use Trudhesa at the first sign of a migraine for the best results.
- Administer the nasal spray exactly as instructed. Prime the device if necessary before using the first dose.
- Avoid using more than the recommended dose, as overuse can lead to serious side effects or rebound headaches.
- Keep track of how often you use Trudhesa. If you need to use it more than the recommended amount, consult your healthcare provider to evaluate your migraine management plan.
- Store the nasal spray at room temperature and keep it away from heat and moisture.
Side Effects of Trudhesa
Common Side Effects
- Nausea or vomiting
- Dizziness or lightheadedness
- Fatigue or drowsiness
- Irritation in the nose or throat
Uncommon/Severe Side Effects
- Heart attack or other heart-related issues (chest pain, shortness of breath).
- Stroke symptoms, such as sudden numbness or weakness, confusion, or trouble speaking.
- Hypertension (increased blood pressure).
- Ergotism: Severe vasoconstriction that can lead to numbness, coldness, or pain in the extremities.
Risks and Warnings of Trudhesa
- Cardiovascular Risk: Like other ergot alkaloids, Trudhesa can cause serious cardiovascular side effects, including heart attack or stroke, particularly in individuals with pre-existing cardiovascular conditions. Avoid use if you have a history of heart disease, stroke, or uncontrolled high blood pressure.
- Drug Interactions: Trudhesa should not be taken with medications that strongly inhibit CYP3A4 enzymes (such as certain antifungals and macrolide antibiotics), as this can lead to dangerous increases in the level of dihydroergotamine and increase the risk of serious side effects.
- Overuse: Overuse of migraine medications can lead to medication overuse headaches (rebound headaches). Consult your healthcare provider if you find yourself needing to use Trudhesa frequently.
Interactions with Trudhesa
Common Drug Interactions
- CYP3A4 Inhibitors: Medications that inhibit the CYP3A4 enzyme (such as itraconazole, ketoconazole, clarithromycin) can increase the levels of dihydroergotamine in the blood, increasing the risk of severe side effects. Trudhesa should not be used with these drugs.
- Triptans: Avoid using Trudhesa within 24 hours of taking a triptan (another type of migraine medication), as this can increase the risk of vasoconstriction and cardiovascular side effects.
- Vasoconstrictors: Use caution when combining Trudhesa with other medications that cause vasoconstriction, as this may increase the risk of side effects.
Alternatives to Trudhesa
- Triptans (sumatriptan, rizatriptan): A class of drugs that target serotonin receptors to alleviate migraines.
- CGRP inhibitors (Aimovig, Emgality): A newer class of medications used to treat and prevent migraines.
- NSAIDs (ibuprofen, naproxen): Over-the-counter anti-inflammatory medications that can help reduce the severity of migraines.
- Other Ergot Derivatives: Medications such as Migranal (dihydroergotamine mesylate) nasal spray, a similar treatment option for migraines.
