Dihydroergotamine

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Contents 1 Introduction 2 Indications 3 Dosage 4 Pharmacokinetics 5 Adverse-effects 6 Drug-interactions 7 Mechanism-of-action 8 More General Terms 9 Internet Database 10 References

Introduction

• Alias DHE 45. Dihydroergotamine mesylate.

Indications

• prevention & treatment of vascular headaches
• adjunct for DVT prophylaxis for hip surgery
• orthostatic hypotension

Dosage

• 1 mg IV/ IM at 1st sign of headache
• repeat in 1 hour PRN, up to 3 mg IM, 2 mg IV
• max dose 6 mg/week ( IV)

• Injection: 1 mg/mL.

Pharmacokinetics

• onset of action is 15-30 minutes
• extensively metabolized by the liver
• 1/2life is 1.3-3.9 hours
• eliminated predominantly into the bile & feces
  

• elimination via liver

Adverse-effects

• common (> 10%)

• localized edema
• peripheral vascular effects

• numbness of fingers & toes
• paresthesias of fingers & toes

• drowsiness
• dizziness
• dry mouth
• diarrhea
• nausea/vomiting

• less common (1-10%)

• chest pressure/pain, transient tachycardia or bradycardia, muscle pain in extremities, weakness in legs

Drug-interactions

• increases effect of heparin
• erythromycin, clarithromycin, nitroglycerin & propranolol increase toxicity
  
• drug interaction(s) of beta-adrenergic receptor antagonists with ergot alkaloids

Mechanism-of-action

• vasoconstriction of peripheral & cerebral vessels via direct stimulation of vascular smooth muscle

More General Terms

• ergot alkaloid
• anti-migraine agent

Internet Database

PubChem: 3066
PubChem: 10531

References

1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
2. Kaiser Permanente Northern California Regional Drug Formulary, 1998
3. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998

dihydroergotamine (DHE 45, Migranal)