Treatment of Migraine with Dihydroergotamine Mesylate

Treatment of Migraine with Dihydroergotamine Mesylate

Dihydroergotamin is a semisynthetic alkaloid of ergot that is hypothesized to exert it is antimigrain efect via its agonist activity at the serotonin 5-HT id reseptor, resulting in vasoconstriction of intracarnial blood veselsand inhibition of inflamatory neuropeptide release. The drug also binds with high affinity to adrenegic and dopamin reseptor, but the antimigraine effect of these events is unknown.Compare with ergotamin Dihydroergotamine is a weaker vasoconstrictor, is less active as an emetic and less oxytocic.

Dyhidroergotamine dosage for adult

IM 1 mg initially, then 1 mg q 1 hr prn, to a maximum of 3mg/day or 6 mg/week.

IV for rapid effect 0.5-1 mg, may repeat in 1 hr to a maximum of 2 mg /day or 6 mg/week. Consider administering metoclopramide 10 mg IV before Dihydroergotamin to treat nausea due to migraine and prevent nausea due to the drug. 

Intranasal one spray (0.5 mg) into each nostril, may repeat in 15 min to a maximum of 2 mg over 24 hr.

Dihydroergotamine dossage for Pediatric Safetyand efficacy not established

Dihydroergotamine Dossage for geriatric Same as addult dossage

Patient Intructions

This drug can cause numbness and tingling in fingers, toes, or face. Notify your physician if you are pregnant or have heart disease or high blood presure. Don't exceed the maximum dosage. nasal spray can cause local irritation. Do not rause the applicator, use the solution right after opening. Review training materials with your health care provider and report the use of all cold or allergy medications and all over the counter medications  

Pharmacokinetics 

Onset & Duration : onset under 5 min IV, within 15-30 min after IM or intranasal spray. Duration 3-4 hr. Intranasal 50-70% of patients of respon in 4 hr 

Adverse Reaction 

frequently report adverse event with intranasal administrasion are rhinitis, pharyngitis, altered sense of taste, application site reactions, nausea, vomiting, and dizziness. wih all routes of administration  vomiting, nausea, diarhea, and local edema ocur frequently. Numbness and tingling of fingges and toes, muscle painin extremities, weak in leg, pruritus, rash, and infection occur occasionally.
Contraindication 
Pregnacy and lactation, periferal vascular disease, coronary artery disease, ischemic heart disease,sepsis, bacilar migraine, recent history of vascular surgery, severely impaired hepatic, hypersensitivity to ergot alkaloids
Precautions
Use caution to avoid overuse by patients with  vascular headaches. patients with risk  for coronary artery disease should undergo periodic cardiovascular evaluation
Drug Inretaction 
antagoniz the antianginal effect of nitrate. the risk of bledding with walfarin is worsened with co administration of Dihydroergotamine. Macrolide including erythromycin can increase the risk of ergot toxicity.