Dihydroergotamine Injection

What is this medication?

DIHYDROERGOTAMINE (dye hye droe er GOT a meen) treats migraines and cluster headaches. It works by blocking pain signals and narrowing blood vessels in the brain. It belongs to a group of medications called ergot alkaloids. It is not used to prevent headaches or migraines.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Brekiya, DHE 45

What should I tell my care team before I take this medication?

They need to know if you have any of these conditions:

• Chest pain
• Diabetes
• Having or recent surgery
• Have had a heart attack, stroke, or mini-stroke
• Heart or blood vessel conditions
• High blood pressure
• High cholesterol
• Infection
• Kidney disease
• Liver disease
• Tobacco use
• An unusual or allergic reaction to dihydroergotamine, other medications, foods, dyes, or preservatives
• Pregnant or trying to get pregnant
• Breastfeeding

How should I use this medication?

This medication is injected under the skin, into a muscle, or into a vein. If it is injected into a muscle or vein, it will be given by your care team in a hospital or clinic setting. It may be given at home if it is injected under the skin.

If you get this medication at home, you will be taught how to prepare and give it. Take it as directed on the prescription label. You will be taught how to prepare and give it. Do not take it more often than directed.

It is important that you put your used needles and syringes in a special sharps container. Do not put them in a trash can. If you do not have a sharps container, call your pharmacist or care team to get one.

Talk to your care team about the use of this medication in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

This does not apply. This medication is not for regular use. It should only be used as needed.

What may interact with this medication?

Do not take this medication with any of the following:

• Bromocriptine
• Chloramphenicol
• Clarithromycin
• Cocaine
• Letermovir
• Levoketoconazole
• Lonafarnib
• Mifepristone
• Nefazodone
• Other medications that constrict blood vessels or increase blood pressure, such as dopamine, droxidopa, ephedrine, epinephrine, isoproterenol, midodrine, norepinephrine, phenylephrine, pseudoephedrine
• Some medications for cancer, such as adagrasib, ceritinib, idelalisib, ribociclib, tucatinib
• Some antivirals for HIV or hepatitis
• Some medications for fungal infections, such as itraconazole, ketoconazole, posaconazole, voriconazole
• Triptans, such as almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan

This medication may also interact with the following:

• Beta-blockers, such as metoprolol or propranolol
• Grapefruit juice
• Fluconazole
• Nicotine
• SSRIs, medications for depression, such as citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
• Zileuton

Other medications may affect the way this medication works. Talk with your care team about all the medications you take. They may suggest changes to your treatment plan to lower the risk of side effects and to make sure your medications work as intended.

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medication?

Visit your care team for regular checks on your progress. Tell your care team if your symptoms do not start to get better or if they get worse.

This medication may affect your coordination, reaction time, or judgment. Do not drive or operate machinery until you know how this medication affects you. Sit up or stand slowly to reduce the risk of dizzy or fainting spells. Drinking alcohol with this medication can increase the risk of these side effects.

Tell your care team right away if you notice unexplained wounds on your fingers or toes while taking this medication. You should also tell your care team if you experience numbness or pain, changes in the skin color, or sensitivity to temperature in your fingers or toes.

If you take migraine medications for 10 or more days a month, your migraines may get worse. Keep a diary of headache days and medication use. Contact your care team if your migraine attacks occur more frequently.

Talk to your care team if you may be pregnant. This medication can cause preterm labor.

Do not breastfeed while taking this medication and for 3 days after the last dose.

What side effects may I notice from receiving this medication?

Side effects that you should report to your care team as soon as possible:

• Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
• Burning, pain, tingling, or color changes in the hands, arms, legs, or feet
• Dry cough, shortness of breath or trouble breathing
• Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
• Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
• Increase in blood pressure
• Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
• Sudden or severe stomach pain, bloody diarrhea, fever, nausea, vomiting
• Pain in the lower back or sides

Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):

• Diarrhea
• Dizziness
• Flushing
• Sweating

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medication?

Keep out of the reach of children and pets.

Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F). Protect from light, moisture, and heat. Do not refrigerate. Do not freeze. Get rid of any unused medication after the expiration date.

To get rid of medications that are no longer needed or have expired:

• Take the medication to a medication take-back program. Check with your pharmacy or law enforcement to find a location.
• If you cannot return the medication, ask your pharmacist or care team how to get rid of this medication safely.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.