Details About Generic Salt ::  Dihydroe

Main Medicine Class:: Analgesic, Migraine, Ergotamine derivative   

(DIE-high-droe-err-GOT-uh-meen MEH-sih-LATE)

D.H.E. 45

Injection: 1 mg/mL

Migranal

Spray, nasal: 4 mg/mL. With 10 mg caffeine and 50 mg dextrose.

Class: Analgesic, Migraine, Ergotamine derivative

Drugs Class ::

 Action Constricts peripheral and cranial blood vessels, depresses central vasomotor centers, and reduces extracranial blood flow.

Indications for Drugs ::

 Indications Acute treatment of migraine headaches with or without aura; acute treatment of cluster headache episodes (injection).

Drug Dose ::

 Route/Dosage

Adults: Intranasal 1 spray (0.5 mg) in each nostril; administer an additional spray (0.5 mg) in each nostril 15 min later for a total dosage of 4 sprays (2 mg).

IM/IV/SC Administer 1 mL (1 mg); repeat dose as needed at 1-hr intervals to a total dose of 3 mL (3 mg) for IM or SC administration or 2 mL (2 mg) for IV administration in a 24-hr period (max, 6 mL/wk).

Contraindication ::

 Contraindications Hypersensitivity to ergot alkaloids; hepatic or renal impairment; severe pruritus; coronary artery disease; uncontrolled peripheral vascular disease; hypertension; sepsis; use during pregnancy, lactation or in women who may become pregnant; concurrent vasoconstrictor therapy. CYP3A4 inhibitors (eg, macrolide antibiotics [eg, erythromycin], protease inhibitors [eg, ritonavir]).

Drug Precautions ::

 Precautions

Pregnancy: Category X. Lactation: Excreted in breast milk and may inhibit lactation. Drug can cause symptoms of ergotism in infant. Children: Safety and efficacy not established. Dependence/Withdrawal syndrome: Dependence/withdrawal has occurred with other ergot alkaloids; therefore, recommended dosage should not be exceeded.

Drug Side Effects ::

 Adverse Reactions

CARDIOVASCULAR: Pulselessness; precordial distress or pain; transient tachycardia or bradycardia; raised arterial pressure; coronary vasoconstriction. GI: Nausea; vomiting; abdominal pain. OTHER: Numbness and tingling of fingers and toes; muscle pain in extremities; weakness in legs; localized edema; itching. Drug has oxytocic and spasmolytic properties.

Drug Mode of Action ::  

 Action Constricts peripheral and cranial blood vessels, depresses central vasomotor centers, and reduces extracranial blood flow.

Drug Interactions ::

 Interactions

Beta-blockers, vasoconstrictors (eg, epinephrine): Can increase peripheral ischemia, cyanosis, and numbness caused by ergot alkaloids. CYP3A4 inhibitors (eg, macrolide antibiotics [eg, erythromycin], protease inhibitors [eg, ritonavir]): May increase the risk of life-threatening peripheral ischemia. Nitrates (eg, nitroglycerin): May oppose effects of nitrates.

Drug Assesment ::

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Determine history of hypersensitivity to dihydroergotamine and ergotamine derivatives.
• Obtain baseline vital signs, with special attention to pulse and BP.
• Evaluate mental status and peripheral neurocirculatory status (eg, sensation, edema, color, weakness).
• Prepare drug in syringe that is free of other drugs and solutions and administer drug undiluted.
• Obtain baseline assessment of pain severity.
• Monitor for changes in vital signs, especially pulse and BP.
• Monitor for changes in mental status (eg, confusion, drowsiness).
• Monitor for effectiveness of headache relief with pain assessments q 15 min and for minimal effective dose.
• Check neurocirculatory status of extremities, especially distally (eg, pulse, warmth, color).

Drug Storage/Management ::

 Administration/Storage

• IM route is preferred. Do not mix with any other drug in syringe or solution.
• For IM administration, inject at first sign of headache. To determine minimal effective dose, adjust dose for several headaches and then use minimal effective dose at onset of subsequent attacks.
• For rapid effect, administer IV. May be given undiluted; give 1 mg or fraction thereof over 1 min.
• After drug is administered, have patient lie supine and relax for few minutes, preferably in quiet, darkened room.
• Avoid prolonged administration or excessive dosage because of danger of ergotism and gangrene.
• Protect ampules from light and heat.

Drug Notes ::

 Patient/Family Education

• Caution patient that this medication must not be taken during pregnancy or when pregnancy is possible. Advise patient to use reliable form of birth control while taking this drug.
• Teach patient to measure or rate drug effectiveness (eg, use analog or other validated rating scale).
• Instruct patient to take drug at first sign of impending headache and not to exceed maximum dosage.
• Advise patient to relax in supine position in quiet, darkened room after drug administration.
• Tell patient to inform health care provider if diagnosed with any peripheral vascular disease.
• Instruct patient to report the following symptoms to health care provider: pain, itching, weakness, tingling, edema, pallor, coolness, numbness (especially in distal extremities), chest discomfort, pain or any change in mental status (eg, drowsiness, light-headedness, syncope, seizures).
• Advise patient to avoid intake of alcoholic beverages, smoking, and exposure to cold because these vasoconstrictors may further impair peripheral circulation and cause or aggravate migraine headache.

Disclaimer ::

The Information available on this site is for only Informational Purpose , before any use of this information please consult your Doctor .Price of the drugs indicated above may not match to real price due to many possible reasons may , including local taxes etc.. These are only approximate indicative prices of the drug.