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Dihydroergotamine mesylate nasal

Important Note

The following information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other healthcare professional. It should not be construed to indicate that use of the drug is safe, appropriate, or effective for you. Consult your healthcare professional before using this drug.




WARNING: Infrequently, a very serious, life-threatening decrease in the amount of blood supply to the hands and feet (peripheral ischemia) and rarely to the brain can occur when this medication is taken with drugs that affect liver metabolism (e.g., potent CYP 3A4 enzyme inhibitors). Do not take this medication with macrolide antibiotics (e.g., erythromycin, clarithromycin, troleandomycin), protease inhibitors (e.g., ritonavir, nelfinavir, indinavir, amprenavir, saquinavir), azole antifungals (e.g., ketoconazole, itraconazole).


This medication is used to treat migraine headache attacks. It is not used to prevent migraines from occurring.

How To Use

Use exactly as directed and do not use more often than prescribed. Learn the proper technique for assembly and use of the nasal spray device. Spray applicator must be primed (pumped 4 times) before use. Consult your pharmacist. This drug is meant to be absorbed through the nostril. Do not inhale deeply through the nose while spraying. Use at the first sign of headache. The usual dose is one spray into each nostril. Repeat one spray into each nostril 15 minutes later. Full relief usually begins in 30 minutes. Four sprays total (2 sprays into each nostril) are advised for a single attack. In the U.S., 6 sprays per day (3 sprays in each nostril) and 8 sprays per week (4 sprays in each nostril) are the maximum doses that should be used. Do not use daily on a regular basis. Consult your doctor or pharmacist regarding how and when to treat additional migraine attacks. Avoid eating grapefruit or drinking grapefruit juice at any time while using this medication unless your doctor instructs you otherwise. Other "ergot" drugs (e.g., ergotamine), methysergide or "triptan-type" drugs (e.g., sumatriptan) should not be used within 24 hours of this drug.

Side Effects

Stuffy or runny nose, sore throat, stomach upset, diarrhea, drowsiness, change in taste sensation and irritation in the nostrils may occur. If these effects persist or worsen, notify your doctor. Unlikely but report promptly: numbness/tingling or unusually cold or bluish colored hands or feet, muscle pain, leg weakness, unusually fast or slow heartbeat, stomach pain, headache. Very unlikely but report promptly: chest discomfort, confusion, swelling, itching, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.


Tell your doctor your medical history, especially of: any allergies (especially drug allergies), blood vessel diseases or surgery, heart disease (especially chest pain), serious infections (sepsis), high blood pressure, liver or kidney disease, diabetes, any history of smoking. Limit alcohol consumption as it may increase the drug's side effects. Because this drug may cause drowsiness, use caution while performing tasks that require alertness (e.g., driving). This drug must not be used during pregnancy. If you become pregnant or think you may be pregnant, inform your doctor immediately. It is not known if this drug is excreted into breast milk. Because of the potential risk to the infant, breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

Drug Interactions

Tell your doctor of all nonprescription and prescription medication you may use, especially: drugs that narrow blood vessels (e.g., ergotamine, sumatriptan, nicotine), beta-blockers (e.g., metoprolol, propranolol), nefazodone, fluconazole, fluoxetine, fluvoxamine, zileuton, clotrimazole, other mild CYP 3A4 enzyme inhibitors. Tell your doctor if you take any medication that makes you drowsy such as: sedatives, sleep medicine, anti-anxiety drugs, anti-seizure drugs, narcotic pain relievers (e.g., codeine), antidepressants (e.g., amitriptyline, fluoxetine, sertraline), certain antihistamines (e.g., diphenhydramine), psychiatric medication (e.g., chlorpromazine, haloperidol). Also see Warning section for additional drug interaction information. Do not start or stop any medicine without doctor or pharmacist approval.


If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include numbness, tingling, or pain in fingers or toes; nausea; vomiting; slowed breathing; lightheadedness; fainting; headache; fast heartbeat; flushing; confusion; seizures; and coma.


Do not share this medication with others.

Missed Dose

This medication is not used on a regularly scheduled basis. It is used on an "as needed" basis and is to be used only as directed by your doctor.


Once the spray applicator has been prepared for use, it must be discarded within 8 hours, even if some drug remains. Store at room temperature between 46 and 77 degrees F (8-25 degrees C) away from light and moisture. This drug cannot be refrigerated or frozen.