Dihydroergotamine Nasal Spray

What is this medication?

DIHYDROERGOTAMINE (dye hye droe er GOT a meen) treats migraines. 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 migraines.

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

COMMON BRAND NAME(S): Migranal, TRUDHESA

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
• Having or recent surgery
• Heart attack
• Heart disease
• High blood pressure
• Infection
• Kidney disease
• Liver disease
• An unusual or allergic reaction to dihydroergotamine, other medications, foods, dyes, or preservatives
• Pregnant or trying to get pregnant
• Breast-feeding

How should I use this medication?

This medication is for use in the nose. Take it as directed on the prescription label at the same time every day. Do not use it more often than directed. Make sure that you are using your nasal spray correctly. Ask your care team if you have any questions.

A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.

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:

• Adagrasib
• Bromocriptine
• Ceritinib
• Certain antibiotics, such as erythromycin or clarithromycin
• Certain antivirals for HIV or hepatitis
• Certain medications for fungal infections, such as itraconazole, ketoconazole, posaconazole, voriconazole
• Certain medications for migraine headache, such as almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan
• Cocaine
• Ergot alkaloids, such as dihydroergotamine, ergonovine, ergotamine, methylergonovine
• Idelalisib
• Imatinib
• Isoproterenol
• Lonafarnib
• Mifepristone
• Nefazodone
• Nitrates
• Pseudoephedrine
• Ribociclib
• Tucatinib

This medication may also interact with the following:

• Certain medications for blood pressure, heart disease, irregular heartbeat
• Certain medications for depression, anxiety, or mental health conditions
• Certain medications for fungal infections, such as clotrimazole or fluconazole
• Nicotine
• Zileuton

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.

Talk to your care team if you wish to become pregnant or think you might be pregnant. This medication can cause serious birth defects.

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.

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 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 to your care team if they continue or are bothersome):

• Change in taste
• Diarrhea
• Dizziness
• Irritation inside the mouth or throat
• Nausea
• Runny or stuffy nose
• Vomiting

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). Do not freeze. Do not refrigerate. Protect from light. Get rid of any unused medication 8 hours after priming the spray.

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, check the label or package insert to see if the medication should be thrown out in the garbage or flushed down the toilet. If you are not sure, ask your care team. If it is safe to put it in the trash, take the medication out of the container. Mix the medication with cat litter, dirt, coffee grounds, or other unwanted substance. Seal the mixture in a bag or container. Put it in the trash.

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.