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Dihydroergotamine - Nasal

Pronunciation: dye-HI-dro-er-GOT-uh-meen

Common Brand Name(s): Migranal

Important: How To Use This Information

This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

Warning

This medication has rarely caused a very serious lack of blood flow to the hands and feet (peripheral ischemia) or to the brain, which could cause a stroke. The risk is increased when this medication is taken with other drugs that can affect the removal of dihydroergotamine from your body. Examples include azole antifungals (such as ketoconazole, itraconazole), cobicistat, mifepristone, certain antidepressants (such as nefazodone), macrolide antibiotics (such as clarithromycin, erythromycin, troleandomycin), HIV protease inhibitors (such as ritonavir, nelfinavir, indinavir), SSRIs (such as fluoxetine, paroxetine, fluvoxamine), among others.

Uses

This medication is used to treat migraine headache attacks. It helps relieve headache pain and other symptoms such as sensitivity to light or sound. Prompt treatment allows you to get back to your normal routine sooner and may decrease your need for other pain medications. This medication is not used to prevent migraines from occurring.

Dihydroergotamine belongs to a class of drugs known as ergot alkaloids. It may work by narrowing the blood vessels in the brain. It may also block other pain pathways in the brain.

How To Use

Read the Patient Information Leaflet or Medication Guide provided by your pharmacist before you start using dihydroergotamine and each time you get a refill. Follow the illustrated directions for the proper use of this medication. If you have any questions, ask your doctor or pharmacist.

Learn all preparation and usage instructions in the product package. If any of the information is unclear, consult your doctor or pharmacist.

This medication comes in individual nasal spray vials. Each vial contains enough medication to treat a single migraine attack. Do not use more than 4 sprays for a single attack. Before using each nasal spray vial, prime the pump by spraying 4 times into the air, away from the face.

At the first sign of a migraine, spray this medication into the nostrils. Do not inject this medication. Use 1 spray into each nostril. Do not tilt your head back, sniff through your nose, or blow your nose while spraying or immediately after. Use another spray into each nostril 15 minutes after the first sprays, or use as directed by your doctor. After using the medication, you should lie down and relax in a quiet, darkened room. The maximum number of sprays you can use for a single attack is 4 sprays (two in each nostril). You should feel some relief within 30 minutes of using this medication.

The dosage is based on your medical condition and response to treatment. Ask your doctor how often you can use this medication to treat your migraine headaches. Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase.

This medication works best if it is used as the first signs of the headache occur. If you wait until the headache has worsened, the medication may not work as well. Use only as needed to treat migraine attacks when they occur. It is not meant for long-term daily use.

If you have never used this medication before and you have risk factors for heart disease (see Precautions), you may need to be monitored for rare but serious side effects (such as chest pain) when you take the first dose. Your doctor may ask you to take the first dose in the office.

If you also take "triptan" or other ergot medications (such as sumatriptan, methysergide), wait 24 hours before and after taking dihydroergotamine. Consult your doctor or pharmacist for more details and for advice on how to time your doses of these medications.

If you are using drugs for migraine attacks on 10 or more days each month, the drugs may actually make your headaches worse (medication overuse headache). Do not use medications more often or for longer than directed. Tell your doctor if you need to use this medication more often, or if the medication is not working as well, or if your headaches get worse.

Side Effects

Precautions

Before using dihydroergotamine, tell your doctor or pharmacist if you are allergic to it; or to other ergot alkaloids (such as ergotamine, methysergide, bromocriptine); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially:

heart disease (such as chest pain/angina, heart attack)
stroke
high blood pressure
blood circulation disease (such as peripheral arterial disease, Raynaud's syndrome)
a certain severe blood infection (sepsis)
bowel disease (such as ischemic bowel syndrome)
kidney disease
liver disease
headaches with unusual symptoms or certain types of headache (hemiplegic/basilar)
recent blood vessel surgery
nasal problems (such as chronic congestion, nasal allergies)

Tell your doctor if you have the following risk factors for heart disease:

high blood pressure
high blood cholesterol
obesity
diabetes
smoking/tobacco use
family history of heart disease

If you are at high risk for heart disease, your doctor may want to check your heart before prescribing dihydroergotamine and give your first dose in the office.

This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).

Using tobacco/nicotine products while using this medication can increase the risk of serious side effects such as heart problems (such as chest pain, fast/slow/irregular heartbeat) and decreased blood supply to the brain/hands/feet. Do not use tobacco while taking this medication. If you smoke, talk to your doctor about how to stop smoking.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using dihydroergotamine. Dihydroergotamine may harm an unborn baby. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication.

This drug may pass into breast milk. Because of the possible risk to the infant, breastfeeding is not recommended while using this drug and for 3 days after the last dose. Consult your doctor before breastfeeding.

Drug Interactions

See also Warning and How to Use sections.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug include:

bronchodilators/decongestants/stimulants (such as epinephrine, pseudoephedrine, methylphenidate, amphetamine)

Some products have ingredients that could raise your heart rate or blood pressure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or other migraine medications).

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Alberta residents can call PADIS (Poison and Drug Information Service) 24 hours a day at 1-800-332-1414. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe/sudden numbness, blue or purple hands/feet, slow/difficult breathing, confusion, seizures.

Notes

Do not share this medication with others.

Lab and/or medical tests (such as EKG) may need to be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.

Certain foods/beverages or food additives (such as red wine, cheese, chocolate, monosodium glutamate, alcohol) as well as some lifestyle patterns (such as irregular eating/sleeping habits, stress) may bring about a migraine headache. Avoiding these "triggers" may help decrease the frequency of migraine headaches. Consult your doctor for more details.

Missed Dose

Take this medication only as needed when a migraine occurs, as directed by your doctor. This medication is not taken on a regular schedule.

If you have questions about missing a dose or you don't have more medication, contact your healthcare provider or pharmacist.

Storage

Store at room temperature away from heat, light, and moisture. Do not freeze or refrigerate. Do not store in the bathroom. Discard opened nasal spray vials 8 hours after opening. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Information last revised October 2023.

Selected from data included with permission and copyright by First DataBank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

Conditions of Use: The information in this database is intended to supplement, not substitute for the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment. The display and use of this drug information is subject to express Terms of Use.

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