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DHE-45 Migraine Abortive - Headache and Migraine Drug Profiles

dihydroergotamine mesylate injectable


Created: August 25, 2006


DHE-45 (dihydroergotamine mesylate)

DHE-45 (dihydroergotamine mesylate, USP) injectable is for the acute treatment of Migraine with or without aura. Ergotamine preparations are non-triptan Migraine abortives. Injectable medications bypass the gastrointestinal tract, making it appropriate for patients who suffer from nausea and vomiting as a result of migraine, and who may therefore have difficulty with oral treatments. DHE-45 is a migraine-specific serotonin agonist. It attacks migraine at its source by selectively binding to receptors in the brain that regulate the release of serotonin, a chemical thought to play a major role in the development of migraine. As other dihydroergotamine medications, DHE-45 has a potential for rebound headaches, aka medication overuse headaches. Thus, it is recommended that it be used no more than two or three days a week.

DHE-45 was first approved by the FDA in 1946..

Type of medication: Rx, abortive, migraine-specific serotonin agonist.


    • Do not use more than two or three days a week as it can cause medication overuse headache, aka rebound.
    • Drinking alcohol can make Migraines worse or trigger additional Migraines. Avoid alcoholic beverages during headache.
    • Some people feel drowsy or dizzy during or after a migraine attack, or after using DHE-45. As long as you are feeling drowsy or dizzy, do not drive, use machines or do anything else that could be dangerous.
    • Do not use within 24 hours of taking a triptan medication.

Pregnancy and Breastfeeding:

    • FDA pregnancy category X. Do not take dihydroergotamine if your are pregnant. Dihydroergotamine can induce uterine contractions, and it can restrict blood flow to the fetus.
    • Dihydroergotamine passes into breast milk and can cause vomiting and diarrhea in a nursing infant. Do not take dihydroergotamine if you are breast-feeding a baby.  

Other medical conditions:
Make sure you tell your doctor if you have any other medical problems, especially those listed below.

    • heart or blood vessel disease
    • chest pain or difficulty breathing
    • problems with blood circulation in your fingers, arms, toes, or legs
    • kidney disease
    • liver disease
    • hypertension (high blood pressure)
    • any infection

Other medications:
Be sure to tell your doctor if you are taking any other prescription or over-the-counter medications, especially:

    • antibiotics such as erythromycin, clarithromycin, and troleandomycin
    • azole antifungal medications such as fluconazole
    • beta blocker/thiazide combinations
    • feverfew
    • fluoxetine
    • fluvoxamine
    • guarana
    • nitrates
    • protease inhibitors
    • triptans: Imitrex, Zomig, Maxalt, Amerge, Relpax, Axert, Frova
    • any other ergot/ergotamine medications
    • Cocaine
    • Epinephrine by injection. e.g., Epi-Pen

Potential side effects:

Check with your doctor right away if any of the following side effects occur:

    • blisters on hands or feet
    • chest pain
    • cough, fever, sneezing, or sore throat
    • feeling of heaviness in chest
    • irregular heartbeat
    • itching of the skin
    • muscle pain or cramps
    • numbness and tingling of face, fingers, or toes
    • pain in arms, legs, or lower back
    • pain in back, chest or left arm
    • pale bluish-colored or cold hands or feet
    • shortness of breath or troubled breathing
    • weak or absent pulses in legs

Other side effects may occur that usually do not need medical attention. They may stop as your body adjusts to the medication. However, check with your doctor if any of the following side effects continue or are bothersome:

    • Burning or tingling sensation, dryness, soreness, or pain in the nose
    • change in sense of taste
    • diarrhea
    • dizziness
    • dry mouth
    • fatigue
    • headache
    • increased sweating
    • nausea and or vomiting
    • muscle stiffness
    • runny and or stuffy nose
    • sudden sweating and feelings of warmth
    • sensation of burning, warmth, or heat
    • sleepiness
    • unexplained nose bleeds
    • unusual tiredness or weakness, anxiety
    • blurred vision
    • cold clammy skin
    • confusion
    • congestion in chest
    • cough
    • decreased appetite
    • depression
    • difficulty swallowing
    • dizziness or lightheadedness when getting up from a lying or sitting position
    • ear pain
    • eye pain
    • fever
    • heartburn
    • increased watering of eyes
    • increased watering of the mouth
    • increased yawning
    • muscle weakness
    • nervousness
    • pinpoint red spots on skin
    • pounding heartbeat
    • red or irritated eyes
    • ringing or buzzing in ears
    • skin rash
    • stomach pain
    • sudden fainting
    • swelling of face, fingers, feet, or lower legs
    • trembling or shaking of hands or feet
    • trouble in sleeping
    • unusual feeling of well being


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