Dihydroergotamine Mesylate, Injection

What are other names for this medicine?

Type of medicine: antimigraine

Generic and brand names: dihydroergotamine mesylate, injection; D.H.E. 45

What is this medicine used for?

This medicine is given by injection (shots) to relieve the pain of migraine and cluster headaches. This medicine does not work for other types of headaches.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine
• a stroke
• heart disease or a heart attack
• high blood pressure
• kidney or liver problems
• problems with circulation or blood vessel disease
• risk factors for heart disease such as smoking, family history of heart disease, diabetes, or high cholesterol.

If you take this medicine with certain drugs that affect the liver, it can have very serious effects on blood supply to the hands, feet, and brain. This medicine may interact with many other medicines. Tell your provider all prescription and nonprescription medicines you take. Do not start or stop any medicine unless you check with your healthcare provider or pharmacist first.

Females of childbearing age: Do not use this medicine during pregnancy because it may harm the baby. Use an effective birth control method while you are taking this medicine. Stop taking this medicine at the first sign that you may be pregnant and contact your healthcare provider right away. Do not breast-feed while you are using this medicine.

How do I use it?

Check the label on the medicine for directions about your specific dose. Take this medicine exactly as your healthcare provider prescribes. Do not take more or take it longer than prescribed. It is not taken on a regular schedule.

The shots are most effective when given at the first sign of a migraine. Your healthcare provider may give you the injection.

Do not take more than 6 mL in any 7-day period unless your healthcare provider specifically tells you to do so. If you are giving yourself these shots, follow the directions that come with the medicine package. Be sure you stay within the dosage limits. Ask your healthcare provider or pharmacist about anything you do not understand.

Do not use any other medicine for migraines within 24 hours of using this medicine.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: nausea, vomiting, weakness, muscle pain, numbness in your fingers or toes, drowsiness, seizures.

What should I watch out for?

Check with your healthcare provider if your migraine headaches get worse, or if the medicine does not seem to work as well as it did when you first started using it.

Do not smoke while using this medicine. Smoking may increase your risk of side effects.

This medicine may make you dizzy or drowsy. Do not drive or operate machinery unless you are fully alert.

This medicine may make you more sensitive to cold temperatures. Dress warmly during cold weather and avoid prolonged exposure to cold temperatures.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (report these to your healthcare provider right away): Numbness and tingling in fingers or toes; cold hands or feet; muscle pain or weakness in arms or legs; chest pain, irregular heartbeat.

Other: Nausea, vomiting, sweating, flushing, dizziness, drowsiness, soreness where injection was given.

What products might interact with this medicine?

Taking this medicine while you are taking other medicine or can change the way this or any of the other medicines work. Also, using these medicines together might cause harmful side effects. Talk to your healthcare provider if you are taking any of these medicines:

• alcohol
• antibiotics such as erythromycin (E.E.S), clarithromycin (Biaxin), telithromycin (Ketek), and metronidazole (Flagyl)
• antidepressants such as nefazodone, fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), escitalopram (Lexapro), citalopram (Celexa), and sertraline (Zoloft)
• antifungal medications such as clotrimazole (Mycelex), fluconazole (Diflucan), itraconazole (Sporanox), and ketoconazole (Nizoral)
• anti-HIV medicines such as ritonavir (Norvir), amprenavir (Agenerase), indinavir (Crixivan), saquinavir (Fortovase, Invirase), and nelfinavir (Viracept)
• beta blockers such as propranolol (Inderal), sotalol (Betapace), and carvedilol (Coreg)
• ephedrine, pseudoephedrine (Sudafed), or phenylephrine (Neo-Synephrine)
• nicotine in any form (cigarettes, gum, patches, nasal spray)
• other medicines to treat migraine headaches such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), zolmitriptan (Zomig), sumatriptan (Imitrex), and rizatriptan (Maxalt)
• quinidine
• sibutramine (Meridia)
• zileuton (Zyflo).

Do not eat grapefruit or drink grapefruit juice while taking this medicine.

Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Keep all medicines out of the reach of children.

Do not share medicines with other people.