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What should I discuss with my healthcare provider before using dihydroergotamine injection (D.H.E. 45)?

Do not use this medication if you are allergic to dihydroergotamine or other ergot medicine such as Ergomar, Cafergot, Migergot, Migranal, or Methergine. Do not use dihydroergotamine injection if you are pregnant or breast-feeding, or if you have:

• a history of heart disease, angina (chest pain), blood circulation problems, or history of a heart attack or stroke;
• coronary artery disease or "hardening of the arteries";
• uncontrolled high blood pressure;
• severe liver or kidney disease;
• a serious infection called sepsis; or
• if you have recently had heart or blood vessel surgery (such as bypass surgery).

Using certain medications together with dihydroergotamine can cause even greater decreases in blood flow than dihydroergotamine used alone, which can lead to dangerous side effects. Do not use dihydroergotamine if you are also using any of the following medications:

• conivaptan (Vaprisol), imatinib (Gleevec), isoniazid (for treating tuberculosis), or nefazodone (an antidepressant);
• diclofenac (Arthrotec, Cataflam, Voltaren, Flector Patch, Solareze);
• clarithromycin (Biaxin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin), or telithromycin (Ketek);
• clotrimazole (Mycelex Troche), itraconazole (Sporanox), ketoconazole (Extina, Ketozole, Nizoral, Xolegal), or voriconazole (Vfend);
• heart or blood pressure medication such as diltiazem (Cardizem, Dilacor, Tiazac), nicardipine (Cardene), quinidine (Quin-G), or verapamil (Calan, Covera, Isoptin, Verelan); or
• HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), saquinavir (Invirase, Fortovase), or ritonavir (Norvir).

Dihydroergotamine can cause rare but serious side effects on the heart, including heart attack or stroke. To make sure you can safely take dihdroergotamine, tell your doctor if you have any of these other conditions:

• breathing problems;
• high blood pressure;
• ischemic bowel disease;
• liver or kidney disease; or
• coronary heart disease (or risk factors that include diabetes, menopause, smoking, being overweight, having high blood pressure or high cholesterol, having a family history of coronary artery disease, being older than 40 and a man, or being a woman who has had a hysterectomy).

FDA pregnancy category X. Dihydroergotamine can cause birth defects. Do not use if you are pregnant. Tell your doctor right away if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

Dihydroergotamine can pass into breast milk and may harm a nursing baby. Dihydroergotamine may also decrease milk production. Do not use if you are breast-feeding a baby.

How should I use dihydroergotamine injection (D.H.E. 45)?

Use exactly as prescribed by your doctor. Never use more than your prescribed dose of dihydroergotamine. Tell your doctor if the medicine seems to stop working as well in treating your migraine attacks.

Dihydroergotamine is injected into a muscle. You may be shown how to use injections at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles and syringes.

Use dihydroergotamine injection as soon as you notice headache symptoms, or after an attack has already begun.

If your headache does not completely go away, you may use a second injection after 1 hour has passed, and a third injection if needed after another hour has passed (a total of 3 injections).

If you still have migraine symptoms after using 3 injections, call your doctor before using any more. If your headache goes away and then comes back, you may use the medication again if it has been at least 6 hours since your last injection.

Do not use more than a total of 3 injections of this medication in any 24-hour period. Do not use more than a total of 6 injections over a period of 7 days.

Dihydroergotamine injection should be clear and colorless. Do not use if the liquid has changed colors or has particles in it. Call your doctor for a new prescription.

If you use dihydroergotamine long-term, your doctor may want to check your heart function periodically using an electrocardiograph or ECG (sometimes called an EKG), a machine that measures electrical activity of the heart.

Store at room temperature away from moisture, heat, and light. Do not use if the expiration date on the label has passed.

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