Dihydroergotamine Nasal Spray

Some medications should not be taken with dihydroergotamine. Using dihydroergotamine with some medications may cause serious blood circulation problems. These problems may cause strokes and death. Make sure you have discussed any medications you are currently taking or plan to take before starting dihydroergotamine with your doctor and pharmacist. Before starting, stopping, or changing any medications while taking dihydroergotamine, please get the advice of your doctor or pharmacist.

You will be given the Medication Guide. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit https://www.fda.gov/Drugs/DrugSafety/ucm085729.htm to obtain the Medication Guide.

Dihydroergotamine nasal spray is used to treat migraine headaches (severe, throbbing headaches that sometimes are accompanied by nausea and sensitivity to sound and light). Dihydroergotamine is in a class of medications called ergot alkaloids. It works by tightening blood vessels in the brain and by stopping the release of natural substances in the brain that cause swelling.

Dihydroergotamine comes as a liquid and as a powder to spray in the nose. Use at the first sign of a migraine headache. Your doctor will tell you how often you should use dihydroergotamine nasal spray. Your doctor will also tell you what to do if your symptoms do not improve or come back after you use dihydroergotamine nasal spray. Dihydroergotamine nasal spray should be given at start of migraine symptoms but can be used at any time during the migraine.

Use dihydroergotamine nasal spray exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

You may use your first dose of dihydroergotamine nasal spray in a doctor's office or other medical facility where you can be monitored for serious reactions.

Using dihydroergotamine nasal spray more than 10 times in a one month period may cause headaches to worsen. To help prevent this from happening, be sure to mark on a calendar or write down days when dihydroergotamine nasal spray is used. Call your doctor if your headaches do not get better or occur more frequently after using dihydroergotamine nasal spray

Your doctor will show you how to use dihydroergotamine nasal spray. Read the written instructions that come with it before using your first dose. Ask your doctor or pharmacist if you have any questions about how to use dihydroergotamine nasal spray.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before using dihydroergotamine nasal spray,

• tell your doctor or pharmacist if you are allergic to this drug, any part of this drug, or any other drugs, foods or substances. Tell your doctor or pharmacist about the allergy and what symptoms you had.
• some medications should not be taken within 24 hours of using dihydroergotamine nasal spray. Tell your doctor or pharmacist if you are taking the following medications: bromocriptine, ergotamine, methylergonovine, methysergide; or other medications for migraine such as almotriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan.
• some medications should not be taken with dihydroergotamine nasal spray. Other medications may cause dosing changes or extra monitoring when taken with dihydroergotamine nasal spray. Make sure you have discussed any medications you are currently taking or plan to take before using dihydroergotamine nasal spray with your doctor and pharmacist. Before starting, stopping, or changing any medications while using dihydroergotamine nasal spray, please get the advice of your doctor or pharmacist.
• the following nonprescription product may interact with dihydroergotamine nasal spray: nicotine or cough and cold combination products that contain phenylephrine or pseudoephedrine. Be sure to let your doctor and pharmacist know that you are taking these medications before you start using dihydroergotamine nasal spray. Do not start these medications while using dihydroergotamine nasal spray without discussing with your healthcare provider.
• tell your doctor if you have or have ever had heart disease; a heart attack; angina (chest pain); high blood pressure; peripheral vascular disease (poor circulation in the blood vessels); sepsis (a severe infection of the blood); surgery on your heart or blood vessels; or kidney or liver disease. Your doctor may tell you not to use dihydroergotamine nasal spray.
• tell your doctor if you have a family history of heart disease and if you have or have ever had high cholesterol; diabetes; Raynaud's disease (a condition that affects the fingers and toes); or lung disease.
• tell your doctor if you are pregnant or plan to become pregnant. If you become pregnant while using dihydroergotamine, call your doctor immediately. Dihydroergotamine can cause preterm labor.
• tell your doctor if you are breastfeeding or plan to breastfeed. You should not breastfeed while you are using dihydroergotamine nasal spray and for 3 days after your last dose.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are using dihydroergotamine.
• tell your doctor if you use tobacco products. Smoking cigarettes while using this medication increases the risk of serious side effects.

Talk to your doctor about eating grapefruit and drinking grapefruit juice while using this medication.

Dihydroergotamine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away.

• stuffy nose
• tingling or pain in the nose or throat
• dryness in the nose
• nosebleed
• taste changes
• upset stomach
• vomiting
• dizziness

Some side effects can be serious. If you experience any of the following symptoms, stop using dihydroergotamine nasal spray and call your doctor immediately or get emergency medical treatment:

• color changes, numbness or tingling in fingers and toes
• muscle pain or cramps in arms and legs
• sudden weakness in arms or legs, drooping of one side of the face, or difficulty speaking or understanding
• pain, tightness, pressure, discomfort, or heaviness in chest, stomach, throat, neck, or jaw; shortness of breath; rapid, pounding, or irregular heartbeat; breaking out in a cold sweat; nausea; vomiting; or lightheadedness
• sudden or severe stomach pain, constipation, nausea, or vomiting; bloody diarrhea; weight loss; or fever
• shortness of breath, cough, extreme tiredness, unusual weight loss, or muscle or joint pain
• swelling
• itching

Dihydroergotamine nasal spray may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and light. Keep dihydroergotamine powder nasal spray sealed in the foil pouch until you are ready to use it. Dispose of unused dihydroergotamine solution (liquid) nasal spray 8 hours after you open the vial. Do not freeze dihydroergotamine solution (liquid) nasal spray.

Keep all medication out of sight and reach of children as many containers are not child-resistant. Always lock safety caps. Place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org

Dispose of unneeded medications in a way so that pets, children, and other people cannot take them. Do not flush this medication down the toilet. Use a medicine take-back program. Talk to your pharmacist about take-back programs in your community. Visit the FDA's Safe Disposal of Medicines website https://goo.gl/c4Rm4p for more information.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include:

• numbness, tingling, and pain in fingers and toes
• blue color in fingers and toes
• slowed breathing
• confusion
• seizures
• coma
• nausea
• vomiting
• stomach pain

Keep all appointments with your doctor. Your doctor may order certain lab tests to check your body's response to dihydroergotamine nasal spray.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

Keep a written list of all of the prescription and nonprescription (over-the-counter) medicines, vitamins, minerals, and dietary supplements you are taking. Bring this list with you each time you visit a doctor or if you are admitted to the hospital. You should carry the list with you in case of emergencies.

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