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Dihydroergotamine

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Dihydroergotamine, Dihydroergotamine Mesylate, DHE-45, Brekiya Auto-Injector

  • See Also
  1. Migraine Abortive Management
  2. Intranasal Dihydroergotamine (Migranal)
  • Indications
  1. Migraine Abortive Management
    1. Largely replaced by Triptans
  • Contraindications
  1. Children
  2. Hemiplegic Migraine (or basilar Migraine)
  3. Ischemic or vasospastic cardiac disease
  4. Sepsis
  5. Peripheral Vascular Disease
  6. Vascular surgery
  7. Renal Impairment
  8. Hepatic Impairment
  9. Uncontrolled Hypertension
  • Mechanism
  1. Ergot derivative acting at alpha adrenergic, serotonergic and Dopaminergic Receptors
  2. Binds and stimulates 5-HT1D receptor, a Serotonin receptor subtype
    1. Constricting Cerebral Vessels
    2. Also acts at trigeminal Sensory Nerve Endings to suppress release of pro-inflammatory neuropeptides
  • Precautions
  1. Give first dose in health care facility in those with Cardiovascular Risk Factors
  • Medications
  1. See Intranasal Dihydroergotamine (Migranal)
  2. Dihydroergotamine (DHE-45) 1 mg/ml
  3. Brekiya Auto-Injector 1 mg/ml injection
    1. Inject into mid-thigh
  • Dosing
  • Adults
  1. See Intranasal Dihydroergotamine (Migranal)
  2. Parenteral Dihydroergotamine
    1. Initial: 1 mg SC/IM/IV over 3-4 minutes
    2. Repeat: May repeat every 1 hour (up to 2 mg IV or 3 mg IM/SC in 24 hours)
    3. Maximum: 6 mg/week, 20 mg/month
  • Adverse Effects
  1. Cerebrovascular Accident
  2. Retroperitoneal fibrosis
  • Safety
  1. Avoid in Pregnancy (Pregnancy Category X)
  2. Avoid in Lactation
  • Drug Interactions
  1. Avoid with concurrent similar agents
    1. Ergotamine
    2. Methysergide
    3. Triptans
  • Efficacy
  1. Advantages
    1. Weaker Vasoconstrictor (less Side Effects)
    2. No Rebound Headache
  • Resources
  1. Dihydroergotamine Mesylate Injection (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=40b9ba9e-436e-444e-b078-01b12bb57ea7