Dosing & Uses
Dosage Forms & Strengths
intrnasal solution (Trudhesa)
- 0.725mg/actuation
intranasal solution (Migranal)
- 0.5mcg/actuation (4mg/ampule with intranasal sprayer)
- Also contains caffeine (10 mg/ampule; 1.25mg/actuation)
Migraine Headache
Indicated for acute treatment of migraine with or without aura
Trudhesa
- 1 spray (0.725 mg) in each nostril (total dose 1.45 mg)
- If needed, may repeat dose a minimum of 1 hr after first dose
- Not to exceed 2 doses (4 sprays)/24 hr 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 hr or 8 sprays (4 mg)/week
Dosing Considerations
Not intended for prophylaxis of migraine
Not for chronic, daily use
Not for management of hemiplegic or basilar migraine
Safety and efficacy not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (44)
- almotriptan
dihydroergotamine intranasal, almotriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- atazanavir
atazanavir will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- clarithromycin
clarithromycin increases toxicity of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Coadministration may result in vasospasm and ischemia of the extremities and other tissues including the CNS.
- conivaptan
conivaptan will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- darunavir
darunavir will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- eletriptan
dihydroergotamine intranasal, eletriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
- erythromycin base
erythromycin base will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- erythromycin lactobionate
erythromycin lactobionate will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- erythromycin stearate
erythromycin stearate will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- fosamprenavir
fosamprenavir will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- frovatriptan
dihydroergotamine intranasal, frovatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- glyceryl trinitrate pr
dihydroergotamine intranasal decreases effects of glyceryl trinitrate pr by pharmacodynamic antagonism. Contraindicated.
- idelalisib
idelalisib will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- imatinib
imatinib increases levels of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- indinavir
indinavir will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- isoniazid
isoniazid will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- itraconazole
itraconazole will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Increased risk of ergotism leading to cerebral ischemia and/or ischemia of the extremities
- ketoconazole
ketoconazole will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- letermovir
letermovir increases levels of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Coadministration of letermovir and ergot alkaloids is contraindicated due to risk of ergotism.
- levoketoconazole
levoketoconazole will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- lopinavir
lopinavir increases levels of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- mifepristone
mifepristone increases levels of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Contraindicated with CYP3A substrates that have a narrow therapeutic index .
- naratriptan
dihydroergotamine intranasal, naratriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- nefazodone
nefazodone will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- nelfinavir
nelfinavir will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- nicardipine
nicardipine increases levels of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- nitroglycerin IV
dihydroergotamine intranasal decreases effects of nitroglycerin IV by pharmacodynamic antagonism. Contraindicated.
- nitroglycerin sublingual
dihydroergotamine intranasal decreases effects of nitroglycerin sublingual by pharmacodynamic antagonism. Contraindicated.
- nitroglycerin topical
dihydroergotamine intranasal decreases effects of nitroglycerin topical by pharmacodynamic antagonism. Contraindicated.
- nitroglycerin transdermal
dihydroergotamine intranasal decreases effects of nitroglycerin transdermal by pharmacodynamic antagonism. Contraindicated.
- nitroglycerin translingual
dihydroergotamine intranasal decreases effects of nitroglycerin translingual by pharmacodynamic antagonism. Contraindicated.
- posaconazole
posaconazole will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- pseudoephedrine
dihydroergotamine intranasal increases effects of pseudoephedrine by pharmacodynamic synergism. Contraindicated. Ergot derivatives may enhance the vasoconstricting effect of pseudoephedrine and eventually significantly increasing blood pressure.
- quinidine
quinidine increases levels of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- ritonavir
ritonavir will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- rizatriptan
dihydroergotamine intranasal, rizatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- saquinavir
saquinavir increases levels of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- sumatriptan
dihydroergotamine intranasal, sumatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- sumatriptan intranasal
dihydroergotamine intranasal, sumatriptan intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- tipranavir
tipranavir increases levels of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- voriconazole
voriconazole will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- zolmitriptan
dihydroergotamine intranasal, zolmitriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
Serious - Use Alternative (97)
- abametapir
abametapir will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.
- aprepitant
aprepitant will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- armodafinil
armodafinil will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- artemether/lumefantrine
artemether/lumefantrine will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- benzphetamine
dihydroergotamine intranasal, benzphetamine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- bosentan
bosentan will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- brigatinib
brigatinib will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Brigatinib induces CYP3A4 in vitro. Coadministration with CYP3A4 substrates, particularly those with a narrow therapeutic index, can result in decreased concentrations and loss of efficacy. If unable to avoid coadministration, monitor CYP3A4 substrate levels and adjust dose as needed.
- bromocriptine
dihydroergotamine intranasal, bromocriptine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. The concomitant use of bromocriptine with ergot alkaloids may potentially lead to ergot toxicity; therefore the combination should be avoided.
- budesonide
budesonide will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- butabarbital
butabarbital will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- butalbital
butalbital will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- carbamazepine
carbamazepine will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- ceritinib
ceritinib will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- cimetidine
cimetidine will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- cobicistat
cobicistat will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- cortisone
cortisone will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- cyclosporine
cyclosporine will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- darifenacin
darifenacin will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- dasatinib
dasatinib will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- dexamethasone
dexamethasone will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- dexfenfluramine
dihydroergotamine intranasal, dexfenfluramine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
dexfenfluramine, dihydroergotamine intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Risk of serotonin syndrome. - dexmethylphenidate
dihydroergotamine intranasal, dexmethylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- dextroamphetamine
dihydroergotamine intranasal, dextroamphetamine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- DHEA, herbal
DHEA, herbal will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- diethylpropion
dihydroergotamine intranasal, diethylpropion. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- diltiazem
diltiazem will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- dobutamine
dihydroergotamine intranasal, dobutamine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- dopamine
dihydroergotamine intranasal, dopamine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- dronedarone
dronedarone will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- efavirenz
efavirenz will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- enzalutamide
enzalutamide will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- ephedrine
dihydroergotamine intranasal, ephedrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- epinephrine
dihydroergotamine intranasal, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- eslicarbazepine acetate
eslicarbazepine acetate will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- etravirine
etravirine will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- fenfluramine
dihydroergotamine intranasal, fenfluramine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
fenfluramine, dihydroergotamine intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Risk of serotonin syndrome. - fluconazole
fluconazole will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- fludrocortisone
fludrocortisone will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- fluvoxamine
fluvoxamine will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- fosaprepitant
fosaprepitant will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- fosphenytoin
fosphenytoin will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- grapefruit
grapefruit will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- griseofulvin
griseofulvin will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- hydrocortisone
hydrocortisone will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- isocarboxazid
isocarboxazid and dihydroergotamine intranasal both increase serotonin levels. Avoid or Use Alternate Drug.
- isoproterenol
dihydroergotamine intranasal, isoproterenol. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- ivosidenib
ivosidenib will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.
- lapatinib
lapatinib will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- lenacapavir
lenacapavir will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of lenacapavir with dihydroergotamine, ergotamine or methylergonovine is not recommended.
- linezolid
linezolid and dihydroergotamine intranasal both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.
- lisdexamfetamine
dihydroergotamine intranasal, lisdexamfetamine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- lumefantrine
lumefantrine will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- marijuana
marijuana will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- methamphetamine
dihydroergotamine intranasal, methamphetamine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- methylene blue
methylene blue and dihydroergotamine intranasal both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.
- methylenedioxymethamphetamine
dihydroergotamine intranasal, methylenedioxymethamphetamine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- methylphenidate
dihydroergotamine intranasal, methylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- methylprednisolone
methylprednisolone will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- metronidazole
metronidazole will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- miconazole vaginal
miconazole vaginal will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- midodrine
dihydroergotamine intranasal, midodrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- nevirapine
nevirapine will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- nifedipine
nifedipine will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- nilotinib
nilotinib will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- nilutamide
nilutamide will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- norepinephrine
dihydroergotamine intranasal, norepinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- oxcarbazepine
oxcarbazepine will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- pentobarbital
pentobarbital will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- phendimetrazine
dihydroergotamine intranasal, phendimetrazine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- phenelzine
phenelzine and dihydroergotamine intranasal both increase serotonin levels. Avoid or Use Alternate Drug.
- phenobarbital
phenobarbital will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- phentermine
dihydroergotamine intranasal, phentermine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- phenylephrine
dihydroergotamine intranasal, phenylephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- phenylephrine PO
dihydroergotamine intranasal, phenylephrine PO. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- phenytoin
phenytoin will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- prednisone
prednisone will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- primidone
primidone will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- procarbazine
procarbazine and dihydroergotamine intranasal both increase serotonin levels. Avoid or Use Alternate Drug.
- propylhexedrine
dihydroergotamine intranasal, propylhexedrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- quinupristin/dalfopristin
quinupristin/dalfopristin will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- rifabutin
rifabutin will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- rifampin
rifampin will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- rifapentine
rifapentine will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- rufinamide
rufinamide will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- secobarbital
secobarbital will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- serdexmethylphenidate/dexmethylphenidate
dihydroergotamine intranasal, serdexmethylphenidate/dexmethylphenidate. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- sotorasib
sotorasib will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the CYP3A4 substrate for dosage modifications
- St John's Wort
St John's Wort will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- topiramate
topiramate will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- tranylcypromine
tranylcypromine and dihydroergotamine intranasal both increase serotonin levels. Avoid or Use Alternate Drug.
- triamcinolone acetonide injectable suspension
triamcinolone acetonide injectable suspension will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- tucatinib
tucatinib will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.
- verapamil
verapamil will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- voxelotor
voxelotor will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.
- xylometazoline
dihydroergotamine intranasal, xylometazoline. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- yohimbine
dihydroergotamine intranasal, yohimbine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.
- zafirlukast
zafirlukast will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
Monitor Closely (74)
- 5-HTP
5-HTP and dihydroergotamine intranasal both increase serotonin levels. Use Caution/Monitor.
- almotriptan
almotriptan and dihydroergotamine intranasal both increase serotonin levels. Use Caution/Monitor.
- amitriptyline
amitriptyline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- amoxapine
amoxapine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- axitinib
dihydroergotamine intranasal increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- belzutifan
belzutifan will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.
- buspirone
buspirone and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- citalopram
citalopram and dihydroergotamine intranasal both increase serotonin levels. Use Caution/Monitor. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
- clomipramine
clomipramine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- cocaine topical
cocaine topical and dihydroergotamine intranasal both increase serotonin levels. Use Caution/Monitor.
- crizotinib
crizotinib increases levels of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of crizotinib with CYP3A substrates with narrow therapeutic indices should be avoided.
- dabrafenib
dabrafenib will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- deferasirox
deferasirox will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Use ergot alkaloids with caution with less potent CYP3A4 inhibitors.
- desipramine
desipramine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- dexfenfluramine
dexfenfluramine and dihydroergotamine intranasal both increase serotonin levels. Use Caution/Monitor.
- dextroamphetamine
dextroamphetamine and dihydroergotamine intranasal both increase serotonin levels. Use Caution/Monitor.
- dextromethorphan
dextromethorphan and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- doxepin
doxepin and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- duloxetine
duloxetine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- duvelisib
duvelisib will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. will increase the level or effect of
- elagolix
elagolix will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered.
- eletriptan
eletriptan and dihydroergotamine intranasal both increase serotonin levels. Use Caution/Monitor.
- encorafenib
encorafenib, dihydroergotamine intranasal. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.
- ergotamine
dihydroergotamine intranasal and ergotamine both increase serotonin levels. Use Caution/Monitor.
- escitalopram
escitalopram and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- fenfluramine
dihydroergotamine intranasal and fenfluramine both increase serotonin levels. Use Caution/Monitor.
dihydroergotamine intranasal decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately. - finerenone
dihydroergotamine intranasal will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.
- fluoxetine
fluoxetine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- fluvoxamine
fluvoxamine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- frovatriptan
frovatriptan and dihydroergotamine intranasal both increase serotonin levels. Use Caution/Monitor.
- iloperidone
iloperidone increases levels of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.
- imipramine
imipramine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- isoniazid
dihydroergotamine intranasal and isoniazid both increase serotonin levels. Use Caution/Monitor.
- istradefylline
istradefylline will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
- L-tryptophan
dihydroergotamine intranasal and L-tryptophan both increase serotonin levels. Use Caution/Monitor.
- larotrectinib
larotrectinib will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- levodopa
dihydroergotamine intranasal and levodopa both increase serotonin levels. Use Caution/Monitor.
- levomilnacipran
levomilnacipran and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- lithium
dihydroergotamine intranasal and lithium both increase serotonin levels. Use Caution/Monitor.
- lofepramine
lofepramine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- lomitapide
dihydroergotamine intranasal increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.
- lsd
dihydroergotamine intranasal and lsd both increase serotonin levels. Use Caution/Monitor.
- maprotiline
maprotiline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- meperidine
dihydroergotamine intranasal and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.
- milnacipran
milnacipran and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- mirtazapine
dihydroergotamine intranasal and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- mitotane
mitotane will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- morphine
dihydroergotamine intranasal and morphine both increase serotonin levels. Use Caution/Monitor.
- naratriptan
naratriptan and dihydroergotamine intranasal both increase serotonin levels. Use Caution/Monitor.
- nefazodone
nefazodone and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- nitroglycerin rectal
nitroglycerin rectal will increase the level or effect of dihydroergotamine intranasal by Other (see comment). Use Caution/Monitor. Oral administration of nitroglycerin markedly decreases the first-pass metabolism of dihydroergotamine and consequently increases its oral bioavailability. Ergotamine is known to precipitate angina pectoris. Therefore the possibility of ergotism in patients receiving nitroglycerin should be considered.
- nortriptyline
nortriptyline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- paroxetine
paroxetine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- pentazocine
dihydroergotamine intranasal and pentazocine both increase serotonin levels. Use Caution/Monitor.
- protriptyline
protriptyline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- rasagiline
rasagiline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- ribociclib
ribociclib will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rizatriptan
rizatriptan and dihydroergotamine intranasal both increase serotonin levels. Use Caution/Monitor.
- rucaparib
rucaparib will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.
- SAMe
dihydroergotamine intranasal and SAMe both increase serotonin levels. Use Caution/Monitor.
- schisandra
schisandra will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- selegiline
selegiline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- selegiline transdermal
selegiline transdermal and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- sertraline
sertraline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- St John's Wort
dihydroergotamine intranasal and St John's Wort both increase serotonin levels. Modify Therapy/Monitor Closely.
- stiripentol
stiripentol, dihydroergotamine intranasal. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
- sumatriptan
sumatriptan and dihydroergotamine intranasal both increase serotonin levels. Use Caution/Monitor.
- sumatriptan intranasal
sumatriptan intranasal and dihydroergotamine intranasal both increase serotonin levels. Use Caution/Monitor.
- tazemetostat
tazemetostat will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tramadol
dihydroergotamine intranasal and tramadol both increase serotonin levels. Use Caution/Monitor.
- trazodone
trazodone and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- trimipramine
trimipramine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- venlafaxine
venlafaxine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.
- zolmitriptan
zolmitriptan and dihydroergotamine intranasal both increase serotonin levels. Use Caution/Monitor.
Minor (24)
- acebutolol
dihydroergotamine intranasal, acebutolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- acetazolamide
acetazolamide will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- anastrozole
anastrozole will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- atenolol
dihydroergotamine intranasal, atenolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- betaxolol
dihydroergotamine intranasal, betaxolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- bisoprolol
dihydroergotamine intranasal, bisoprolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- carvedilol
dihydroergotamine intranasal, carvedilol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- celiprolol
dihydroergotamine intranasal, celiprolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- cyclophosphamide
cyclophosphamide will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- esmolol
dihydroergotamine intranasal, esmolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- green tea
green tea increases levels of dihydroergotamine intranasal by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Due to caffeine content.
- labetalol
dihydroergotamine intranasal, labetalol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- metoprolol
dihydroergotamine intranasal, metoprolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- nadolol
dihydroergotamine intranasal, nadolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- nebivolol
dihydroergotamine intranasal, nebivolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- nicotine inhaled
dihydroergotamine intranasal, nicotine inhaled. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- nicotine intranasal
dihydroergotamine intranasal, nicotine intranasal. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- penbutolol
dihydroergotamine intranasal, penbutolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- pindolol
dihydroergotamine intranasal, pindolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- propranolol
dihydroergotamine intranasal, propranolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- ruxolitinib
dihydroergotamine intranasal will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ruxolitinib topical
dihydroergotamine intranasal will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- sotalol
dihydroergotamine intranasal, sotalol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- timolol
dihydroergotamine intranasal, timolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
Adverse Effects
>10%
Rhinitis (26%)
1-10%
Nausea (10%)
Altered taste (8%)
Application site reactions (6%)
Vomiting (4%)
Somnolence (3%)
Paraesthesia (2%)
Pharyngitis (3%)
Diarrhea (2%)
Sinusitis (1%)
Hot flashes (1%)
Fatigue (1%)
Asthenia (1%)
Dry mouth (1%)
Stiffness (1%)
Warnings
Black Box Warnings
Serious and/or life-threatening peripheral ischemia has been reported with coadministration of this drug with potent CYP3A4 inhibitors (including protease inhibitors and macrolide antibiotics)
Because CYP3A4 inhibition elevates the serum ergotamine levels, the risk of vasospasm leading to cerebral ischemia and/or ischemia of the extremities is increased
Concurrent use of these potent CYP3A4 inhibitors are contraindicated
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
Cautions
Coadministration with less potent CYP3A4 inhibitors
Fibrotic complications reported (pleural and retroperitoneal fibrosis with prolonged parenteral use)
May cause coronary vasospasm
Avoid in patients with unrecognized CAD (ie, patient with risk factors)
May cause vasospastic reactions including myocardial, peripheral vascular, and colonic ischemia
May elevate blood pressure
Pregnancy & Lactation
Pregnancy Category: X
Lactation: Contraindicated; excreted in human milk and is known to inhibit prolactin
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Binds with high affinity to 5-HT-1Dα and 5-HT-1Dβ; also bind to serotonin 5-HT-1A, -2A, and -2C receptors, noradrenaline α2A, α2B, and alpha receptors, and dopamine D2L and D3 receptors
Therapeutic activity attributed to agonist effect at 5-HT-1D receptors, which includes vasoconstriction of intracranial blood vessels, or activation of 5-HT1D may inhibit proinflammatory neuropeptide release
Absorption
Bioavailability: 32%
Distribution
Protein bound: 93%
Vd: 800 L
Metabolism
Metabolites: 8'-β-hydroxydihydroergotamine (active); metabolites represent 20-30% of plasma AUC
Elimination
Half-life: 10 hr
Renal clearance: 0.1 L/min
Total body clearance: 1.5 mL/min
Excretion: Major excretory route is in the bile and feces; urine 2%
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Formulary
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