Dihydroergotamine (Nasal)

Dihydroergotamine nasal solution is used to provide relief from the pain and other symptoms caused by migraine headaches.

Overview

Dihydroergotamine nasal solution is used to treat the painful and debilitating symptoms that are caused by migraine headaches. It is also sometimes used to manage withdrawal from analgesics and to treat acute intractable headaches. However, dihydroergotamine cannot be used to treat any other form of bodily pain.

Dihydroergotamine is one of a group of drug called ergot alkaloids. The medication works by causing vasoconstriction of the blood vessels inside the skull. It also acts centrally on the adrenergic, serotonin, and dopamine receptors within the brain.

It should be noted that dihydroergotamine sometimes causes the blood vessels elsewhere in the body to constrict, potentially causing circulatory problems in vulnerable people.

In the US, dihydroergotamine is known under the brand name, Migranal. This drug is only available on prescription from your GP or treating specialist.

Conditions treated

  • Migraine headaches
  • Analgesic withdrawal (where severe headache is a side effect)

Type of medicine

  • Ergot alkaloid
  • Nasal spray

Side effects

Some medications cause unwanted side effects, as well as the effects they are designed to produce. Not all the side effects mentioned in this guide will be experienced by patients using dihydroergotamine. However, if you do notice any odd effects when using this drug, you may need to see your doctor for further treatment.

If any of the following side effects are noted, you must check with your GP without delay:

  • Weak or lack of pulse in the legs
  • Very cold hands or feet
  • Tingling or numbness of the fingers, toes or face
  • Sore throat, cough, sneezing, or fever
  • Shortness of breath or breathing problems
  • Pale bluish-colored feet or hands
  • Pain in the back, left arm, or chest
  • Pain in lower back, arms, or legs
  • Itching skin
  • Feeling of heaviness in the chest
  • Erratic or irregular heartbeat
  • Chest pain

In the event of an overdose of dihydroergotamine, the following symptoms may by observed. If you think that you have overdosed, seek urgent medical attention.

  • Tingling, numbness, and/or pain in the legs or arms
  • Stomach pain
  • Shortness of breath
  • Nausea and/or vomiting
  • Headaches
  • Dizziness
  • Delirium
  • Convulsions
  • Confusion

There are some effects that you may experience that do not need any medical treatment. These effects usually disappear as treatment progresses and your body gets used to the new drug. If any of the effects become particularly troublesome or persistent, your GP will be able to offer you some advice on how you can manage or prevent them. The following effects may affect you when you first begin treatment with this medicine:

  • Vomiting
  • Unusual tiredness or weakness
  • Unusual feeling of well being
  • Unexplained nose bleeds
  • Trembling or shaking of feet or hands
  • Swelling of feet, face, lower legs or fingers
  • Sudden sweating and feelings of excessive warmth
  • Sudden fainting
  • Stuffed up or runny nose
  • Stomach pain
  • Sore throat
  • Sleepiness
  • Skin rash
  • Sensation of heat or burning
  • Ringing or buzzing in ears
  • Red or irritated eyes
  • Pounding heartbeat
  • Pinpoint red spots on skin
  • Nervousness
  • Nausea
  • Muscle weakness
  • Muscle stiffness
  • Insomnia
  • Increased watering of mouth
  • Increased watering of eyes
  • Increased sweating
  • Heartburn
  • Headache
  • Fever
  • Fatigue
  • Eye pain
  • Excessive yawning
  • Ear pain
  • Dryness, pain, soreness, or a tingling, burning sensation in the nose
  • Dry mouth
  • Dizziness or lightheadedness when rising from a lying or seated position
  • Dizziness
  • Difficulty swallowing
  • Diarrhea
  • Depression
  • Decreased appetite
  • Cough
  • Confusion
  • Cold clammy skin
  • Chest congestion
  • Change in sense of taste
  • Blurred vision
  • Anxiety

Some side effects are experienced by patients, which are not listed here. If you experience any other strange or unexpected effects when using this medication, have a chat with your GP.

Dosage

In order for this drug to work correctly, you must use it properly. Be sure to read the information leaflet that accompanies the product and ask your GP if you have any questions or are unsure how to use the spray.

You must not use dihydroergotamine to treat any headache other than a migraine. Ask your doctor for advice on this.

For dihydroergotamine to be as fully effective as possible, you must use it as soon as you feel a migraine developing. However, do not take the medication until the actual headache starts. If you experience familiar warning signals, such as an aura, wait until the actual headache pain begins before using dihydroergotamine nasal spray.

If possible, lay down in a darkened, quiet room after using the medication. This should help to dispel the migraine.

You should use dihydroergotamine as directed by your GP. However, if your headache returns following initial relief as a result of using the drug, you may use one further dose. That said, you should not ideally use more of the medication or use it more frequently than you have been told to.

Your treating physician may recommend another medicine to take in order to prevent headaches. You should follow your doctor's instructions, even if the headaches continue to happen. In some patients, headache medication can take a few weeks to become fully effective. Once the drugs begin to work, you should experience fewer headaches, and they should be less debilitating and easier to relieve. Ultimately, this should mean that you can reduce the dose of dihydroergotamine nasal spray and other analgesic drugs that you need to take. If there is no appreciable improvement following a few weeks of using headache prevention medication, you should speak to your GP.

Using dihydroergotamine nasal spray

You should note that the dose of dihydroergotamine nasal spray will vary between patients. Always follow the dosage instructions given to you by your GP or those on the product label. The information contained in this guide is based on the average for this medicine. If you have been prescribed a different dose, do not alter it unless your GP advises you to do so.

Your recommended dose will depend on the potency of the preparation you are prescribed. The number of daily doses you use, the time you must leave between them, and the total duration of your course of dihydroergotamine will be dependent on your condition and how your body responds to the drug.

For migraine headaches nasal spray:

  • Adults: Daily dose, apply one spray in each nostril. Repeat after 15 minutes.

  • Children: Your GP will advise on dose and frequency of use.

Drug interactions

Some drugs should never be used at the same time as dihydroergotamine. However in some cases, where the patient's condition merits it, two or more medicines may be used with dihydroergotamine nasal spray, even though an interaction may occur. In such circumstances, your GP may decide to change the dose of one or more of the drugs, or may suggest precautions that you can take to mitigate the effects of any interaction that does occur.

If you are already taking any of the drugs shown in the bulleted list below, you must tell your GP before you begin using dihydroergotamine. It is not recommended that you use dihydroergotamine nasal spray with any of the following medicines. Your GP may decide to change one or both of your medications or might change the doses:

  • Zolmitriptan
  • Voriconazole
  • Troleandomycin
  • Tipranavir
  • Telaprevir
  • Sumatriptan
  • Spiramycin
  • Saralasin
  • Saquinavir
  • Roxithromycin
  • Rokitamycin
  • Rizatriptan
  • Ritonavir
  • Pseudoephedrine
  • Propylhexedrine
  • Posaconazole
  • Phenylpropanolamine
  • Norepinephrine
  • Nelfinavir
  • Nefazodone
  • Naratriptan
  • Miokamycin
  • Mifepristone
  • Midodrine
  • Mepartricin
  • Lopinavir
  • Lidocaine
  • Ketoconazole
  • Josamycin
  • Itraconazole
  • Indinavir
  • Idelalisib
  • Frovatriptan
  • Fosamprenavir
  • Erythromycin
  • Epinephrine
  • Eletriptan
  • Dirithromycin
  • Delavirdine
  • Darunavir
  • Cocaine
  • Cobicistat
  • Clarithromycin
  • Boceprevir
  • Azithromycin
  • Atazanavir
  • Amprenavir
  • Amifampridine
  • Almotriptan

It is not generally advisable to use dihydroergotamine with any of the following drugs, although your GP may deem it appropriate in your case. If you are told to take both medicines at the same time, your doctor may alter the dose or frequency of use of one or both of the drugs:

  • Telithromycin
  • Siltuximab
  • Sibutramine
  • Secukinumab
  • Ranolazine
  • Propatyl Nitrate
  • Pitolisant
  • Pazopanib
  • Lumacaftor
  • Imatinib
  • Golimumab
  • Fluvoxamine
  • Fluconazole
  • Enzalutamide
  • Eluxadoline
  • Dexfenfluramine
  • Crizotinib
  • Conivaptan
  • Ceritinib
  • Bromocriptine
  • Blinatumomab
  • Alefacept

Using dihydroergotamine nasal spray with any of the drugs listed below could cause a high risk of some side effects. However, using both medicines together could be the best course of treatment in your case. If you are told to use both these drugs together, your GP may change the dose or frequency of one or both products:

  • Nitroglycerin
  • Propranolol

Other interactions

Some drugs should not be taken with food or with certain food groups, as an interaction might occur. In addition, using tobacco or alcohol with some drugs can cause interactions. While you are using dihydroergotamine nasal spray to treat your migraines, you should not eat large amounts of grapefruit or drink a lot of grapefruit juice.

Before beginning your treatment with dihydroergotamine, you should discuss with your GP the potential ramifications of using tobacco, alcohol, and specific food groups at the same time as taking this medication.

Warnings

Before you decide to use dihydroergotamine nasal spray, you should consider the risks and benefits of doing so. Your doctor will provide you with a full overview of the pros and cons of using this drug.

You may be advised not to drink alcohol while you are using dihydroergotamine, as doing so can make headaches much worse or encourage headaches to occur more frequently.

Many migraine sufferers feel dizzy or drowsy following a migraine or following a dose of dihydroergotamine nasal spray. If you feel at all unwell, dizzy, drowsy or experiencing visual disturbance, do not drive or operate machines.

If you are allergic to any forms of dihydroergotamine or to any other forms of prescription or over the counter medications, you must tell your GP. It is also important that you mention any other allergies you have to particular food groups, food dyes, animal derivatives, or preservatives.

Pregnancy and breastfeeding

Dihydroergotamine must not be used by pregnant women, as studies have shown that this drug presents a risk to the fetus. If you think that you are pregnant or if you are planning on getting pregnant during your treatment program with dihydroergotamine, you should tell your GP straight away.

This drug is passed into breast milk. Do not breastfeed while you are taking dihydroergotamine as it may harm your infant. Either ask your doctor to prescribe you an alternative migraine medicine or refrain from breastfeeding while you are using this drug.

Other medical conditions

If you have other medication conditions in addition to migraines, this could affect your use of dihydroergotamine. You must discuss your medical history in full with your GP before you commence treatment with this drug.

If you suffer from blood vessel or heart disease, have high blood pressure (hypertension), have kidney or liver disease, or if you have a chronic infection, you must not use dihydroergotamine. This drug can cause serious side effects in people with these conditions. Heart disease, blood vessel disease, and hypertension can sometimes go undetected by the sufferer. For this reason, your doctor may decide to carry out blood tests to make sure that you do not have any of these conditions, before deciding to treat you with dihydroergotamine.

Storage

You should keep this medication in its original packaging, in a sealed container where it will not be exposed to sources of heat, direct sunlight, or moisture. You should not refrigerate or freeze dihydroergotamine nasal spray.

Do not allow children or pets to gain access to dihydroergotamine nasal spray.

Do not use any medicine that has become out-of-date or if the packaging appears to have been opened or is damaged.

Dispose of any unused medicines responsibly and safely. Do not pour dihydroergotamine nasal spray down the drain or toilet. Wrap unwanted or unused medicines in a sealed bag and place them out of sight in your trash can, where children and animals cannot get hold of them. Alternatively, take unused medicine to your pharmacy or GP for safe disposal.

Summary

Dihydroergotamine nasal solution is used to combat the debilitating symptoms that are caused by migraine headaches. The drug is also used in some cases to treat severe headaches. This drug is not suitable for the treatment of any other form of pain.

There is a wide range of drugs that should not be used at the same time as dihydroergotamine nasal solution as side effects may occur as a result of an interaction between the medicines. There are also a few medical conditions that preclude the use of this drug. In addition, dihydroergotamine should not be used during pregnancy or when breastfeeding, as doing so presents a danger to the unborn baby or nursing infant.

During the course of your treatment with dihydroergotamine, you should be sure to see your doctor on a regular basis. Your doctor will need to monitor your progress on the drug and may need to adjust the dose as your condition improves, as well as helping you to manage any side effects that may occur.