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dihydroergotamine (DHE 45, Migranal)
Alias DHE 45. Dihydroergotamine mesylate.
Indications:
1) prevention & treatment of vascular headaches
2) adjunct for DVT prophylaxis for hip surgery
3) orthostatic hypotension
Contraindications:
- pregnancy
- oxytocin-like effects can induce labor [4]
Dosage:
1) 1 mg IV/IM at 1st sign of headache
2) repeat in 1 hour PRN, up to 3 mg IM, 2 mg IV
3) max dose 6 mg/week (IV)
Injection: 1 mg/mL.
Pharmacokinetics:
1) onset of action is 15-30 minutes
2) extensively metabolized by the liver
3) 1/2life is 1.3-3.9 hours
4) eliminated predominantly into the bile & feces
Adverse effects:
1) common (> 10%)
- localized edema
- peripheral vascular effects
- numbness of fingers & toes
- paresthesias of fingers & toes
- drowsiness
- dizziness
- dry mouth
- diarrhea
- nausea/vomiting
2) less common (1-10%)
- chest pressure/pain, transient tachycardia or bradycardia, muscle pain in extremities, weakness in legs
Drug interactions:
1) increases effect of heparin
2) erythromycin, clarithromycin, nitroglycerin & propranolol increase toxicity
Mechanism of action:
- vasoconstriction of peripheral & cerebral vessels via direct stimulation of vascular smooth muscle
Interactions
drug interactions
General
anti-migraine agent
ergot alkaloid
Properties
MISC-INFO: elimination route LIVER
pregnancy-category X
safety in lactation -
Database Correlations
PUBCHEM correlations
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998
- NEJM Knowledge+ Pain Management and Opioids: Recharge