DIHYDROERGOTAMINE INJ,SOLN
Clinical Criteria Summary
Indications
- Acute treatment of migraine with or without aura in adults
- Acute treatment of cluster headaches in adults
Dosage & Administration
- 1 mg subcutaneously at the first sign of migraine
- Additional 1 mg doses may be administered at 1-hour intervals
- Maximum of 3 mg in 24 hours
- Maximum of 6 mg total in a week
- Administered via prefilled autoinjector for self-administration
Safety, Contraindications & Warnings
- Contraindicated in ischemic heart disease/coronary artery vasospasm, uncontrolled hypertension, peripheral artery disease, sepsis, following vascular surgery, severe hepatic or renal impairment, latex allergy, use of serotonin agonists or ergot-type medications within 24 hours, and concomitant use of peripheral and central vasoconstrictors
- Boxed warning for serious/life-threatening peripheral ischemia associated with co-administration of strong CYP3A4 inhibitors
- Monitor for cerebrovascular hemorrhage, subarachnoid hemorrhage, stroke, increased blood pressure, medication overuse headache, pleural and retroperitoneal fibrosis
- Top 5 adverse effects: nausea, vomiting, diarrhea, dizziness, drowsiness
Drug Interactions & Special Populations
- Beta blockers and nicotine may worsen or provoke vasoconstriction
- Selective serotonin reuptake inhibitors rarely associated with weakness, hyperreflexia, and incoordination
- Not recommended during pregnancy due to risk of preterm labor
- Breastfeeding should be avoided during treatment and for 3 days after the last dose due to ergotamine excretion in breastmilk and reported infant adverse effects (vomiting, diarrhea, weak pulse, unstable blood pressure)
Place in Therapy & Utilization Criteria
- Not recommended as a first-line treatment for acute migraine or cluster headache
- Considered when all other recommended agents with better safety profiles have failed
- Appropriate for patients who have experienced inefficacy, intolerance, or contraindications to preferred evidence-based alternatives
- Preferred over glass ampules in niche clinical situations requiring outpatient self-administration of DHE injection
- Slower onset of efficacy compared to triptans but offers better prevention of headache recurrence within 24 hours