If you’re taking any of the following medications, you should avoid taking dihydroergotamine: macrolide antibiotics like clarithromycin (Biaxin), erythromycin (E.E.S., E-Mycin, Erythrocin), or troleandomycin; antifungals like itraconazole (Sporanox) and ketoconazole (Nizoral); HIV protease inhibitors like indinavir (Crixivan (TAO).

Migraine headaches (severe, throbbing headaches occasionally accompanied by nausea and sensitivity to sound and light) and cluster headaches are both treated with dihydroergotamine (severe headaches usually on one side of the head or around one eye). Dihydroergotamine belongs to the group of drugs known as ergot alkaloids. It functions by constricting blood arteries in the brain and by preventing the release of naturally occurring chemicals that enlarge the brain.

Dihydroergotamine is available as a solution for injection into the muscle, subcutaneously (under the skin), or intravenously (into a vein). Dihydroergotamine can be administered intramuscularly or intravenously in a doctor’s office or hospital to treat migraine or cluster headaches, or it can be administered subcutaneously at home to treat a migraine headache. If the headache persists, further dose(s) may be administered every hour, but no more than 3 total doses should be administered subcutaneously, intramuscularly, or intravenously in a 24-hour period of time. No more than six doses of dihydroergotamine should be administered in a single week, and it shouldn’t be used daily. Ask your doctor or chemist to explain any instructions on your prescription label that you do not understand, and carefully follow their instructions. Use dihydroergotamine as indicated. Use only as directed by your doctor, neither more nor less of it, nor more frequently.

If used excessively, dihydroergotamine can harm the heart and other organs. Only migraines that are already well underway should be treated with dihydroergotamine. Dihydroergotamine should not be used to treat a headache that is not a migraine or to stop a migraine from starting.

Your doctor might prescribe you dihydroergotamine for the first time there so they can observe how you react to it and make sure you know how to use the injection or nasal spray properly. You can then administer dihydroergotamine at home. When using dihydroergotamine for the first time at home, make sure you and anybody who will be assisting you inject the medication have read the manufacturer’s information for the patient that is included with it.

Never re-use syringes when administering the solution by injection. Syringes should be disposed of in a container that won’t puncture. For disposal instructions on the puncture-resistant container, consult your doctor or chemist.

Follow these procedures to use the solution for injection:

• Make sure your ampule is safe to use by checking it. If the ampule has cracks or breaks, is marked with an expiration date that has passed, or is filled with colourful, hazy, or particle-laden liquid, do not use it. Use another ampule after returning the first one to the pharmacist.
• Use soap and water to thoroughly wash your hands.
• Verify that the entire amount of liquid is at the ampule’s bottom. Use your finger to gently flick any liquid at the top of the ampule until it falls to the bottom.
• With one hand, grasp the ampule’s base. Using your other hand’s thumb and pointer, hold the top of the ampule. Your thumb should be placed over the ampule’s top dot. Your thumb should be used to force the ampule’s top backward until it separates.
• Insert the needle into the ampule while tilting it 45 degrees.
• When the top of the plunger is level with the dose your doctor instructed you to inject, carefully and steadily pull back the plunger.
• Check to see whether there are any air bubbles in the syringe while holding it with the needle pointed up. If there are air bubbles in the syringe, tap it with your finger until they rise to the top. Once you see a drop of medication at the needle’s tip, carefully press the plunger up.
• If you had to remove air bubbles, double-check the syringe to make sure the dose is right. Repeat steps 5 through 7 if the syringe does not contain the appropriate dose.
• Choose a location well above the knee on either thigh for the injection. Use a hard, circular motion to wipe the area with an alcohol swab, then let it air dry.
• With one hand, hold the syringe; with the other, grasp a fold of skin at the injection site. At an angle between 45 and 90 degrees, insert the needle all the way into the skin.
• Pull back on the plunger a little bit while keeping the needle within the skin.
• Repeat step 11 if blood is found in the syringe by slightly pulling the needle out of the skin.
• For the injection of the drug, fully depress the plunger.
• At the same angle you entered it, swiftly remove the needle from the skin.
• Rub the injection site while pressing a fresh alcohol pad on it.

Ask your doctor or chemist for more details if you believe this drug should be used for something else.

Before using dihydroergotamine,

• Inform your doctor and chemist if you have any allergies to other ergot alkaloids, including bromocriptine (Parlodel), ergonovine (Ergotrate), ergotamine (Cafergot, Ercaf, and others), methylergonovine (Methergine), and methysergide (Sansert).
• Dihydroergotamine shouldn’t be taken within 24 hours of ergot alkaloids like bromocriptine (Parlodel), ergonovine (Ergotrate), ergotamine (Cafergot, Ercaf, and others), methylergonovine (Methergine), and methysergide (Sansert); or other migraine medications like frovatriptan (Frova), naratriptan (Amerge) (Zomig).
• Inform your doctor and chemist about any additional prescription and over-the-counter drugs, vitamins, herbal items, and nutritional supplements you are taking. Incorporate any of the following: drugs for colds and asthma; beta blockers such propranolol (Inderal); clotrimazole (Lotrimin); epinephrine (Epipen); fluconazole (Diflucan); oral contraceptives (birth control pills), nefazodone (Serzone), selective serotonin reuptake inhibitors (SSRIs) as citalopram (Celexa), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft), saquinavir (Fortovase, Invirase), verapamil ( (Zyflo). Your doctor might need to adjust your medication doses or keep a close eye out for any negative side effects.
• Inform your doctor if you have or have ever had high blood pressure, high cholesterol, diabetes, Raynaud’s disease (a condition that affects the fingers and toes), any disease that affects your circulation or arteries, sepsis (a severe blood infection), surgery on your heart or blood vessels, a heart attack, kidney, liver, or heart disease. Also mention any conditions that affect your kidney, liver, or lungs.
• Inform your doctor if you are expecting, intend to get pregnant, or are nursing a baby. Dial your doctor right away if you become pregnant while taking dihydroergotamine.
• Inform your doctor or dentist that you are using dihydroergotamine if you are having surgery, including dental surgery.
• If you use tobacco products, let your doctor know. The risk of major adverse effects is increased when using this medication with smoking.

If you plan to consume grapefruit juice while taking this medication, consult your doctor.

Side effects from dihydroergotamine are possible. If any of these symptoms are severe or do not go away, let your doctor know.

• Blocked nose
• Nose or throat tingling or pain
• Nasal dries out
• Nosebleed
• Changing tastes
• Uneasy stomach
• Vomiting
• Dizziness
• Extreme fatigue
• Weakness

Some adverse effects may be severe. Make a quick call to your doctor if you encounter any of the following signs:

• Alterations in colour, tingling or numbness in the fingers and toes
• Arm and leg pain from muscle
• Weakened back and arms
• Chest ache
• Heart rate accelerating or decelerating
• Swelling
• Itching
• Pale, icy skin
• Slow or challenging speech
• Dizziness
• Faintness

Further negative effects of dihydroergotamine could exist. If you experience any strange issues while taking this drug, call your doctor right away.

You or your doctor can submit a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting programme online or by phone if you have a serious side event (1-800-332-1088).

Keep this medication tightly closed in the original container and out of the reach of children. Keep it away from excessive heat and moisture at room temperature (not in the bathroom). Avoid freezing or refrigeration. After opening the ampule, dispose of any leftover injection medication right away.

To make sure that pets, kids, and other people cannot take leftover pharmaceuticals, they should be disposed of in a specific manner. You shouldn’t flush this medication down the toilet, though. The best option to get rid of your medication is instead through a medication take-back programme. To find out about take-back initiatives in your neighbourhood, speak with your chemist or get in touch with your city’s waste/recycling agency. If you do not have access to a take-back programme, you can find more information at the FDA’s Safe Disposal of Medications website (http://goo.gl/c4Rm4p).

Although many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and are simple for young children to open, it is crucial to keep all medications out of sight and out of reach of children. Always lock safety caps and promptly stash medication up and away from young children where it is out of their sight and reach to prevent poisoning. http://www.upandaway.org

Call the poison control hotline at 1-800-222-1222 in the event of an overdose. Moreover, information can be found online at https://www.poisonhelp.org/help. Call 911 right once if the person has collapsed, experienced a seizure, is having difficulty breathing, or cannot be roused.

Overdose symptoms could include:

• Tingling, numbness, and discomfort in the fingers and toes
• Fingers and toes are blue
• Decreased breathing
• Uneasy stomach
• Vomiting
• Fainting
• Fuzzy vision
• Dizziness
• Confusion
• Seizures
• Coma
• Stomach pain

Keep all of your doctor’s appointments. To determine how your body reacts to dihydroergotamine, your doctor could prescribe specific tests.

Do not share your medication with anybody else. Any queries you may have regarding prescription refills should be directed to your chemist.

You should keep a written record of every medication you take, including any over-the-counter (OTC) items, prescription drugs, and dietary supplements like vitamins and minerals. This list should be brought with you whenever you see a doctor or are admitted to the hospital. You should always have this information with you in case of emergencies.