Yes

Ergot Derivative

Aborts or prevents vascular headaches; also as an adjunct for DVT prophylaxis for hip surgery, for orthostatic hypotension, xerostomia secondary to antidepressant use, and pelvic congestion with pain

X

High-dose aspirin therapy, hypersensitivity to dihydroergotamine or any component. DHE should not be used within 24 hours of sumatriptan, zolmitriptan, other serotonin agonists or ergot-like agents. DHE should be avoided during or within 2 weeks of discontinuing MAO inhibitors. Pregnancy is contraindicated. Contraindicated with ritonavir, nelfinavir and amprenavir.

Use with caution in hypertension, angina, peripheral vascular disease, impaired renal or hepatic function; avoid pregnancy

>10%:

Cardiovascular: Localized edema, peripheral vascular effects (numbness and tingling of fingers and toes)

Central nervous system: Drowsiness, dizziness

Gastrointestinal: Xerostomia, diarrhea, nausea, vomiting

1% to 10%:

Cardiovascular: Precordial distress and pain, transient tachycardia or bradycardia

Neuromuscular & skeletal: Muscle pain in the extremities, weakness in the legs

Symptoms of overdose include peripheral ischemia, paresthesia, headache, nausea, vomiting

Activated charcoal is effective at binding certain chemicals; this is especially true for ergot alkaloids

Increased effect of heparin

Increased toxicity with erythromycin, clarithromycin, nitroglycerin, propranolol, troleandomycin, protease inhibitors. Ritonavir, amprenavir and nelfinavir increase blood levels of ergot alkaloids. Avoid concurrent use.

Store in refrigerator

Ergot alkaloid alpha-adrenergic blocker directly stimulates vascular smooth muscle to vasoconstrict peripheral and cerebral vessels; also has effects on serotonin receptors

Onset of action: Within 15-30 minutes

Duration: 3-4 hours

Distribution: V_d: 14.5 L/kg

Protein binding: 90%

Metabolism: Extensively in the liver

Half-life: 1.3-3.9 hours

Time to peak serum concentration: I.M.: Within 15-30 minutes

Elimination: Predominately into bile and feces and 10% excreted in urine, mostly as metabolites

Adults:

I.V.: Up to 2 mg maximum dose for faster effects; maximum dose: 6 mg/week

Intranasal: 1 spray (0.5 mg) of nasal spray should be administered into each nostril; repeat as needed within 15 minutes, up to a total of 6 sprays in any 24-hour period and no more than 8 sprays in a week

Dosing adjustment in hepatic impairment: Dosage reductions are probably necessary but specific guidelines are not available

Prior to administration of nasal spray the nasal spray applicator must be primed (pumped 4 times); in order to let the drug be absorbed through the skin in the nose, patients should not inhale deeply through the nose while spraying or immediately after spraying; for best results, treatment should be initiated at the first symptom or sign of an attack; However, nasal spray can be used at any stage of a migraine attack

Minimum concentration for vasoconstriction is reportedly 0.06 ng/mL

Drowsiness is common

None reported

No information available to require special precautions

>10% of patients experience dry mouth

Take this drug as rapidly as possible when first symptoms occur. Rare feelings of numbness or tingling of fingers, toes, or face may occur; use caution and avoid injury. May cause drowsiness; avoid activities requiring alertness until effects of medication are known. Report heart palpitations, severe nausea or vomiting, or severe numbness of fingers or toes. Pregnancy/breast-feeding precautions: Inform prescriber if you are pregnant. Do not get pregnant during or for 1 month following therapy. Consult prescriber for instruction on appropriate contraceptive measures. This drug may cause severe fetal defects. Do not breast-feed.

Injection, as mesylate: 1 mg/mL (1 mL)

Spray, nasal: 4 mg/mL [0.5 mg/spray] (1 mL)