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Generic Name: Dihydroergotamine (dye-hye-droe-er-GOT-a-meen)
Brand Name: D.H.E. 45

D.H.E. 45 (Dihydroergotamine) is used in preventing or treating intense migraine headache without or with ambience viz. flashing lights, dark spots or wavy lights and cluster headache. It is an ergot cognate. It works by building up blood vessels in the brain, which helps to overcome migraine headache.

Drug Description:

D.H.E. 45 (Dihydroergotamine) is ergotamine combination in the 9, 10 position as the mesylate salt. The drug is known chemically as ergotaman-3’, 6’, 18-trione, 9, 10-dihydro-12’-hydroxy-2’-methyl-5’(phenylmethyl) (5')-, monomethanesulfonate. Its molecular weight is 679. 80 and its practical formula is C13H37N5O5 · CH4O3S. The drug is found in colorless solution supplied in for I.V., I.M., or subcutaneous (beneath skin)

Composition containing per ml:

dihydroergotamine mesylate,

1 mg

methanesulfonic acid/sodium hydroxide,

pH 3.6 ± 0. 4

alcohol

6.1 % by vol.

glycerin

15% by wt.

water for injection,

1 ml .

 

Indication:

D.H.E. 45 (Dihydroergotamine mesylate) Injection, is determined for the keen treatment of migraine headaches with or without aura and the keen treatment of cluster headache incident.

Dosage:

The drug should be directed in a dose of 1mL within the vein (intravenous), within muscles (intramuscular) or beneath the skin (subcutaneously). The dosage can be repeated as per the need, approximately at 1 hour intervals to a total dosage of 3mL. The total weekly dosage should not exceed 6mL.

Inject at first sign of migraine or as soon as possible after symptom onset.
For I.V. use, drug may be injected undiluted over 1 minute.

Route

Onset

Peak

Duration

I.V.

<5 min

15 min-2 hr

8 hr

I.M., subcut.

15-30 min

15 min-2 hr

8 hr

Nasal

Within 30 min

Unknown

Unknown

Over Dosage:

Over dosage of the drug may cause in incidental clues and symptoms of ergotism. Generally, the symptoms of an intense D.H.E. 45 (Dihydroergotamine mesylate) Injection, overdose are similar to ergotamine overdose, though there is less conspicuous nausea and vomiting with D.H.E. 45 (Dihydroergotamine mesylate) injection.

Ergotamine overdose may include the following symptoms: numbness, itching, pain and discoloration of skin in the extremities correlated with curtailed or absent peripheral pulses; respiratory uneasiness,  an rapid increase and/or decrease in blood pressure, hallucination, contraction of muscles and come; and some degree of nausea, vomiting and abdominal pain.

Using Guide for the Drug:

  1. Dihydroergotamine drug is injected into muscles. You may be guided to use injections at home. Avoid self-injecting this medication if you do not fully understand how to use the injection and dispose used needles and syringes in a proper way.
  2. Dihydroergotamine injection is suggested to inject as soon as headache symptoms are seen, or after an attack has already begun.
  3. If headache is still not healed, use a second injection after 1 hour has passed, and third injection if needed after another hour has passed (a total of 3 injections).
  4. Avoid using more than a total of 3 injections of this medication in 24hour period. Strictly avoid using more than a total of 6 injections over a period of 7 days.
  5. Do not use if the liquid has changed colors or has any undefined particles in it. Dihydroergotamine injection should be clear and colorless.
  6. Check package of the drug to be sure it is safe to use. Do not use the drug if the package is broken, cracked, labeled with an expiration date that has passed, or contains any colored or with cloudy particle-filled liquid.
  7. The drug should be stored at room temperature away from moisture, heat, and contact with light. Do not use if the expiration date on the label has passed. Check the package before using it.
  8. Keep this drug, as well as syringes and needles, away from children and pets. Avoid reusing needles, syringes, or other materials. Follow the guide book for disposal of the used material. Follow all local rules for disposal.

Supply and Storage of Drug:

The drug is found in a clear, colorless, sterile solution in single 1 mL sterile flask or bottle containing 1 mg of dihydroergotamine mesylate per mL, in packages of 10.

The drug is suggested to be stored below 77° F(25° C), in light-resistant containers. The drug should be avoided from refrigeration or freezing. To maintain constant efficiency, protect the container from light and heat. Use the drug only if it stays clear and colorless before its consumption.

Precautions:

  • Avoid the medication if you are allergic to D. H. E. 45 other ergot alkaloids (e.g., ergotamine). This product may contain inactive ingredients, which may cause allergic reactions or other problems.
  • This drug may make you dizzy or sleepy. Avoid driving, use machinery, or do any activity that requires alertness until you are sure you can complete such activities cautiously. Limit intake of alcoholic beverages while getting treated with this drug. Remember that alcohol may be a cause of headaches.
  • This medication should be avoided in case of certain medical conditions. Consumption of the drug should be taken care of if you are suffering from: blood circulation disease (e.g., peripheral vascular disease such as arteriosclerosis, thrombophlebitis, Raynaud's disease), uncontrolled high blood pressure, heart/blood vessel disease (e.g., coronary artery disease, stroke, angina, heart attack), liver disease, kidney disease, severe blood infection (sepsis), recent blood vessel surgery.
  • Intake of tobacco/nicotine commodity while using this medication can raise the risk of serious side effects such as heart problems (such as chest pain, irregular heartbeat) and decreased or slower blood supply to the brain, hands or feet. Do not use tobacco and avoid smoking while taking this medication.
This medication may harm an unborn baby. Therefore, it is not suggested to be used during pregnancy. It is recommended that men and women can use 2 adequate forms of birth control (e.g., condoms, birth control pill) while using this medication. If you become pregnant or think you may be pregnant, consult your doctor for more details and to discuss possible forms of birth control.