D. H. E. 45 (Dihydroergotamine) Patient Information: How Should I Take the Drug at RxList

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May 26, 2012

DHE 45

Migraine »

What is a migraine headache?

A migraine headache is a form of vascular headache. Migraine headache is caused by vasodilatation (enlargement of blood vessels) that causes the release of chemicals from nerve fibers that coil around the large arteries of the brain. Enlargement of these blood vessels stretches the nerves that coil around them and causes the nerves to release chemicals. The chemicals cause inflammation, pain, and further enlargement of the artery. The increasing enlargement of the arteries magnifies the pain.

Migraine attacks commonly activate the sympathetic nervous system in the body. The sympathetic nervous system is often thought of as the part of the nervous system that controls primitive responses to stress and pain, the so-called "fight or flight" response, and this activation causes many of the symptoms associated with migraine attacks; for example, the increased sympathetic nervous activity in the intestine causes nausea, vomiting,...

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D. H. E. 45 User Reviews >>

D. H. E. 45

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D. H. E. 45 Patient Information including How Should I Take

What should I discuss with my healthcare provider before using dihydroergotamine injection (D. H. E. 45)?

Do not use this medication if you are allergic to dihydroergotamine or other ergot medicine such as ergotamine (Ergomar, Ergostat, Cafergot, Ercaf, Wigraine), ergonovine (Ergotrate), methylergonovine (Methergine), or methysergide (Sansert).

Do not use dihydroergotamine injection if you are pregnant or breast-feeding, or if you have:

a history of heart disease, angina (chest pain), blood circulation problems, or history of a heart attack or stroke;
coronary artery disease or "hardening of the arteries";
uncontrolled high blood pressure;
severe liver disease;
severe kidney disease;
a serious infection called sepsis; or
if you have recently had heart or blood vessel surgery (such as bypass surgery).

Using certain medications together with dihydroergotamine can cause even greater decreases in blood flow than dihydroergotamine used alone. A severe decrease in blood flow to the brain and other parts of the body can lead to dangerous side effects. Do not use dihydroergotamine if you are also using any of the following medications:

conivaptan (Vaprisol);
diclofenac (Arthrotec, Cataflam, Voltaren, Flector Patch, Solareze);
imatinib (Gleevec);
isoniazid (for treating tuberculosis);
an antibiotic such as clarithromycin (Biaxin), dalfopristin/quinupristin (Synercid), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin), telithromycin (Ketek), or troleandomycin (Tao);
an antifungal medication such as clotrimazole (Mycelex Troche), itraconazole (Sporanox), ketoconazole (Nizoral), or voriconazole (Vfend);
an antidepressant such as nefazodone;
heart or blood pressure medication such as diltiazem (Cardizem, Dilacor, Tiazac), nicardipine (Cardene), quinidine (Quinaglute, Quinidex, Quin-Release), or verapamil (Calan, Covera, Isoptin, Verelan); or
HIV/AIDS medicine such as amprenavir (Agenerase), atazanavir (Reyataz), delavirdine (Rescriptor), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), saquinavir (Invirase, Fortovase), or ritonavir (Norvir).

Dihydroergotamine can cause rare but serious side effects on the heart, including heart attack or stroke. If you have certain conditions, you may need a dose adjustment or special tests to safely use this medication. Before using dihydroergotamine, tell your doctor if you have:

breathing problems;
high blood pressure;
ischemic bowel disease;
liver disease;
kidney disease; or
coronary artery disease (or risk factors that include diabetes, menopause, smoking, being overweight, having high blood pressure or high cholesterol, having a family history of coronary artery disease, being older than 40 and a man, or being a woman who has had a hysterectomy).

FDA pregnancy category X. This medication can cause birth defects. Do not use dihydroergotamine if you are pregnant. Tell your doctor right away if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

Dihydroergotamine passes into breast milk and may be harmful to a nursing infant. Dihydroergotamine may also decrease milk production. Do not use dihydroergotamine if you are breast-feeding a baby.

How should I use dihydroergotamine injection (D. H. E. 45)?

Use this medication exactly as prescribed by your doctor. Never use more than your prescribed dose of dihydroergotamine. Follow the directions on your prescription label. Tell your doctor if the medicine seems to stop working as well in treating your migraine attacks. Dihydroergotamine is not for daily use.

Dihydroergotamine injection is given as a shot into a muscle or under the skin. Your doctor, nurse, or other healthcare provider will show you how to inject your medicine at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles and syringes.

Your doctor may want to give your first dose of this medicine in a hospital or clinic setting to quickly treat any serious side effects that occur.

Use the first dose of dihydroergotamine as soon as you notice headache symptoms, or after an attack has already begun. The usual dose of dihydroergotamine injection is 1 milliliter (1 mL) per injection.

If your headache does not completely go away, you may use a second injection after 1 hour has passed, and a third injection if needed after another hour has passed (a total of 3 injections).

If you still have migraine symptoms after using a total of 3 injections, call your doctor before using any more. If your headache goes away and then comes back, you may use the medication again if it has been at least 6 hours since your last injection.

Do not use more than a total of 3 injections of this medication in any 24-hour period. Do not use more than a total of 6 injections over a period of 7 days.

Dihydroergotamine injection should be clear and colorless. Do not use if the liquid has changed colors or has particles in it. Call your doctor for a new prescription.

If you use dihydroergotamine long-term, your doctor may want to check your heart function periodically using an electrocardiograph or ECG (sometimes called an EKG), a machine that measures electrical activity of the heart. This will help your doctor determine if it is still safe for you to use this medication. Do not miss any scheduled visits to your doctor.

Do not give this medication to anyone else, even if they have the same headache symptoms you have. Dihydroergotamine can be dangerous if it is used to treat headache in a person who has not been diagnosed by a doctor as having true migraine headaches.

Store dihydroergotamine at room temperature away from moisture, heat, and light. Do not use any stored dihydroergotamine if the expiration date on the label has passed.

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