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; HIV protease inhibitors like indinavir (Crixivan); or antifungals like itraconazole (Sporanox) and ketoconazole (Nizo (TAO).

Migraine headaches can be treated with dihydroergotamine (severe, throbbing headaches that sometimes are accompanied by nausea and sensitivity to sound and light). 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 nasal spray. The recommended dosage for dihydroergotamine nasal spray (Migranal), which is used to treat migraine headaches, is one spray in each nostril followed by another spray in each nostril after 15 minutes, for a total of four sprays. To treat migraine headaches, dihydroergotamine nasal spray (Trudhesa) is administered as one spray in each nostril. A second dose of Trudhesa, a nasal spray containing dihydroergotamine, can be administered if a headache persists after an hour. No more than 4 sprays (2 doses) of any dihydroergotamine nasal spray product should be administered in a 24-hour period, and no more than 6 sprays (3 doses) in a seven-day period. Although it can be used at any time while having a migraine, dihydroergotamine nasal spray should be administered as soon as the first symptoms appear. Ask your doctor or chemist to explain any instructions on your prescription label that you are unsure about following. Follow the directions on the dihydroergotamine nasal spray exactly. Use it only as directed by your doctor, neither more nor less often.

Your first dosage of dihydroergotamine nasal spray can be administered in a clinic or other healthcare setting where you can be watched closely for any negative responses.

More than ten applications of dihydroergotamine nasal spray within a month may make headaches worse. Make sure to mark the days that dihydroergotamine nasal spray is used on a calendar or note them down to assist avoid this.

Follow these steps to use the nasal spray:

1. Before using the nasal spray for the first time, be sure you have read all of the manufacturer’s directions.
2. Before using the product, do not assemble the sprayer.
3. Take off the vial’s blue cap, metal seal, and grey rubber stopper.
4. Spray pump’s plastic lid should be removed, and the vial should be attached to the pump’s base. Clockwise turn the vial until it is firmly fastened to the pump.
5. In order to prime the pump, prime the nasal spray four times while holding the device upright and directed away from you. Spray no more than four times.
6. After primed, turn the pump so that it is facing you while maintaining its upright position, push it into the first nostril until it is comfortable, and then gently depress the pump to release the dose into the nostril. Repeat in the second nostril after that.
7. Avoid sniffing through the nose when using the nasal spray for dihydroergotamine (Migranal) or immediately after. Sniffing during or after nasal spray for the dihydroergotamine (Trudhesa) product is not necessary but is not harmful.

For a copy of the manufacturer’s information for the patient, ask your chemist or doctor.

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

Before using dihydroergotamine nasal spray,

• Inform your physician and pharmacist if you have any allergies to dihydroergotamine, other ergot alkaloids like bromocriptine (Parlodel), ergonovine (Ergotrate), ergotamine (Cafergot, Ercaf, and others), methylergonovine (Methergine), and methysergide (Sansert), as well as any other medications.
• Dihydroergotamine shouldn’t be taken within 24 hours of taking 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). Dihydroergotamine should not be combined with drugs that are used to increase blood pressure, such as droxidopa (Northera), epinephrine (Epipen), midodrine (Orvaten), phenylephrine (Biorphen, Vazculep; in Pherazine and a number of over-the-counter cold treatments), and pseudoephedrine (Sudafed).
• Inform your doctor and chemist about any additional prescription and over-the-counter drugs, vitamins, herbal items, and nutritional supplements you are taking. Make sure to mention any of the following: some antifungals like clotrimazole (Mycelex), fluconazole (Diflucan), beta blockers like propranolol (Inderal), nefazodone (Serzone), oral contraceptives (birth control pills), selective serotonin reuptake inhibitors (SSRIs) like citalopram (Celexa), fluoxetine (Prozac, Sarafem), fluvoxamine (Zyflo). Your physician might need to adjust the dosage of your drugs or keep a close eye on you for 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. You could be advised by your doctor not to take dihydroergotamine.
• 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 grapefruits or 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 medicine, contact 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 light at room temperature. Useless nasal spray should be thrown away eight hours after opening the vial.

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

Unused prescriptions must be disposed of carefully to prevent pets, kids, and other people from ingesting them. You should not, however, dispose of this medication in the toilet. Instead, utilising a medicine take-back programme is the easiest approach to get rid of your medication. To find out about take-back programmes in your area, speak with your chemist or the garbage/recycling agency in your city. If you do not have access to a take-back programme, see the FDA’s Safe Disposal of Medications website at http://goo.gl/c4Rm4p for additional information.

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
• The fingers and toes are blue.
• Decreased breathing
• Uneasy stomach
• Vomiting
• Fainting
• Fuzzy vision
• Dizziness
• Confusion
• Seizures
• Coma
• Abdominal pain

Keep all of your doctor’s appointments. To monitor your body’s reaction to dihydroergotamine, your doctor could request specific lab tests.

No one else should take your medication. 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.