Dihydroergotamine Intranasal

Dihydroergotamine Intranasal is a prescription medication used for the acute treatment of migraine with or without aura.

• Dihydroergotamine Intranasal is available under the following different brand names: Migranal, Trudhesa

Common side effects of Dihydroergotamine Intranasal include:

• nasal congestion or irritation
• changes in the sense of taste
• sore throat
• nausea
• vomiting
• dizziness
• fatigue
• runny or stuffy nose
• nosebleeds
• headache
• drowsiness
• anxiety
• depression
• cold sweats
• pain, soreness, burning, tingling, or dryness in the nose or throat

Serious side effects of Dihydroergotamine Intranasal include:

• hives
• difficulty breathing
• swelling of the face, lips, tongue, or throat
• sudden numbness or weakness (especially on one side of the body)
• sudden severe headache
• slurred speech
• problems with vision or balance
• chest pain or heavy feeling
• pain spreading to the jaw or shoulder
• nausea
• sweating
• general ill feeling
• muscle pain in your arms or legs
• weakness of the legs
• numbness or tingling
• pale or blue-colored appearance in the fingers or toes
• swelling or itching in any part of the body
• stomach cramps
• bloody diarrhea
• severe headache
• blurred vision
• buzzing in the ears
• anxiety
• confusion
• chest pain
• shortness of breath
• uneven heartbeats
• seizure

Rare side effects of Dihydroergotamine Intranasal include:

• none 

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, coordination loss, unsteady, very stiff muscles, high fever, profuse sweating, or tremors.
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult dosage

Intranasal solution (Trudhesa)

• 0.725 mg/actuation
• Intranasal solution (Migranal)
• 0.5 mcg/actuation (4mg/ampule with intranasal sprayer)
• Also contains caffeine (10 mg/ampule; 1.25mg/actuation)

Migraine headache

Adult dosage

Trudhesa

• 1 spray (0.725 mg) in each nostril (total dose 1.45 mg)
• If needed, may repeat the dose a minimum of 1 hour after the first dose
• Not to exceed 2 doses (4 sprays)/24 hours or 3 doses (6 sprays)/week

Migranal

• 1 spray (0.5 mg) in each nostril, repeat after 15-30 minutes for a total of 4 sprays (2 mg)
• Not to exceed 6 sprays (3mg)/24 hours or 8 sprays (4 mg)/week

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Dihydroergotamine Intranasal has severe interactions with at least 44 other drugs
• Dihydroergotamine Intranasal has serious interactions with at least 96 other drugs
• Dihydroergotamine Intranasal has moderate interactions with at least 76 other drugs
• Dihydroergotamine Intranasal has minor interactions with at least 24 other drugs

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your healthcare professional or doctor for additional medical advice, health questions, or concerns.

Contraindications

Hypersensitivity

• Peripheral vascular disease, severe hepatic/renal impairment, ischemic heart disease, uncontrolled hypertension, sepsis, pregnancy, breastfeeding women
• Recent vascular surgery
• Hemiplegic or basilar migraine
• Coadministration with potent CYP3A4 inhibitors
• Peripheral or central vasoconstrictors

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Dihydroergotamine Intranasal?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Dihydroergotamine Intranasal?”

Cautions

• Coadministration with less potent CYP3A4 inhibitors
• Fibrotic complications reported (pleural and retroperitoneal fibrosis with prolonged parenteral use)
• May cause coronary vasospasm
• Avoid patients with unrecognized coronary artery disease (ie, patients with risk factors)
• May cause vasospastic reactions including myocardial, peripheral vascular, and colonic ischemia
• May elevate blood pressure

Pregnancy and Lactation

• Do not use during pregnancy. The risks involved outweigh the potential benefits. Safer alternatives exist.
• Lactation
  • Contraindicated; excreted in human milk and is known to inhibit prolactin