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MIGRANAL (DIHYDROERGOTAMINE MESYLATE)
- Migraine
0.5 mg/pump act. (4 mg/mL) nasal spray
- Spray 1 spray (0.5 mg) by intranasal route in each nostril, repeat in15Min (total 4 sprays); max 6 sprays(3Mg)/day or 8 sprays(4Mg)/week
dihydroergotamine 0.5 mg/pump act. (4 mg/mL) nasal spray
- Spray 1 spray (0.5 mg) by intranasal route in each nostril, repeat in15Min (total 4 sprays); max 6 sprays(3Mg)/day or 8 sprays(4Mg)/week
Migraine
- Spray 1 spray (0.5 mg) by intranasal route in each nostril, repeat 15Minutes later for a total of 4 sprays (2 mg); do not exceed 6 sprays (3 mg) per day or 8 sprays (4 mg) per week
- Spray 1 spray (0.5 mg) by intranasal route in each nostril, repeat in15Min (total 4 sprays); max 6 sprays(3Mg)/day or 8 sprays(4Mg)/week
- almotriptan malate
- Alsuma
- Amerge
- amoxicil-clarithromy-lansopraz
- Aptivus
- atazanavir
- Atripla
- Axert
- Biaxin
- Biaxin Xl
- Biaxin Xl Pak
- boceprevir
- clarithromycin
- conivaptan in 5 % dextrose
- Crixivan
- darunavir
- delavirdine
- efavirenz
- efavirenz-emtricitabin-tenofov
- eletriptan HBr
- elvitegr-cobicist-emtric-tenof
- Erythrocin
- erythromycin
- erythromycin-sulfisoxazole
- fosamprenavir
- Frova
- frovatriptan
- Imitrex
- Imitrex Statdose Kit Refill
- Imitrex Statdose Pen
- Incivek
- indinavir
- Invirase
- itraconazole
- Kaletra
- Ketek
- ketoconazole
- Korlym
- Lexiva
- lopinavir-ritonavir
- Maxalt
- Maxalt-mlt
- Mifeprex
- mifepristone
- naratriptan
- nefazodone
- nelfinavir
- Norvir
- Norvir Soft Gelatin
- Noxafil
- Omeclamox-pak
- omeprazole-clarith-amoxicillin
- Onmel
- posaconazole
- Prevpac
- Prezista
- Relpax
- Rescriptor
- Reyataz
- ritonavir
- rizatriptan
- saquinavir mesylate
- Sporanox
- Sporanox Pulsepak
- Stribild
- sumatriptan
- sumatriptan succinate
- Sumavel Dosepro
- Sustiva
- telaprevir
- telithromycin
- tipranavir
- Vaprisol
- Vfend
- Vfend Iv
- Victrelis
- Viracept
- voriconazole
- zolmitriptan
- Zomig
- Zomig Zmt
Contraindicated
- Bidil
- Dilatrate-sr
- dopamine
- dopamine in D5W
- enzalutamide
- Imdur
- Isochron
- Isoditrate
- isosorbide dinitrate
- isosorbide mononitrate
- isosorbide-hydralazine
- Minitran
- Nitro-bid
- Nitro-dur
- Nitro-time
- nitroglycerin
- nitroglycerin in 5 % dextrose
- Nitrolingual
- Nitromist
- Nitrostat
- Xtandi
Severe
Moderate
- None
- Coronary artery disease
- Lactating mother
- Peripheral vascular disease
- Pregnancy
- Prinzmetal angina
- Sepsis
- Severe hepatic disease
- Severe renal impairment
- Severe uncontrolled hypertension
- Vascular surgery
Contraindicated
- Hypertension
- Increased cardiovascular event risk
- Porphyria
Severe
Moderate
- None
MIGRANAL (DIHYDROERGOTAMINE MESYLATE)
- Migraine
- None
- Diarrhea
- Dizziness
- Drowsy
- Drug-induced hot flash
- Dysgeusia
- Fatigue
- General weakness
- Hyperhidrosis
- Muscle rigidity
- Nasal passage irritation
- Nausea
- Paresthesia
- Pharyngitis
- Sinusitis
- Vomiting
- Xerostomia
More Frequent
Severe
Less Severe
- None
- None
Less Frequent
Severe
Less Severe
Rare / Very Rare
Severe
- Acute myocardial infarction
- Angina
- Cardiac arrhythmia
- Coronary artery spasm
- Myocardial ischemia
- Peripheral ischemia
- Pleural fibrosis
- Pulmonary fibrosis
- Retroperitoneal fibrosis
- Upper respiratory infection
- Valvular sclerosis
Less Severe
- Abdominal pain with cramps
- Acute confusion
- Anorexia
- Blurred vision
- Bronchitis
- Clammy skin
- Conjunctivitis
- Depression
- Dyspepsia
- Dysphagia
- Dyspnea
- Earache
- Edema
- Eye tearing
- Fever
- Hypotension
- Insomnia
- Muscle weakness
- Nervousness
- Ocular pain
- Orthostatic hypotension
- Palpitations
- Petechiae
- Pruritus of skin
- Sialorrhea
- Skin rash
- Symptoms of anxiety
- Tinnitus
- Tremor
- Yawning
Contraindicated
None
Severe Precaution
None
Management or Monitoring Precaution
Dihydroergotamine
Safety and efficacy not established in children.
- 1 Day – 13 Years
- Safety and efficacy not established in children.
Dihydroergotamine Mesylate (inj;Nasal)
- Severity Level:
X
- Additional Notes:
Contraindicated
Dihydroergotamine
May inhibit prolactin; infants exposed to ergotamine had n/v and convulsions
| General | Excretion Potential | Effect on Infant | Notes |
| Drug should not be given to breast feeding mothers | Excreted | Drug shown to have adverse effect | May inhibit prolactin; infants exposed to ergotamine had n/v and convulsions |
Precaution Exists
None
| General | Excretion Potential | Effect on Infant | Notes |
| None |
No Known Risk
None
| General | Excretion Potential | Effect on Infant | Notes |
| None |
Contraindicated
None
Precaution Exists
Dihydroergotamine Mesylate
General-More likely to experience complications such as induced hypothermia and ischemia.
| Organ / System | HEP | REN | CARD | ENDO | NEURO / PSYCH | PULM |
| Increased Risk / Adverse Effects | Y | N | Y | N | N | N |
BEERS: N HEDIS: N STOPP: N
No Known Risk
None
- This medication has rarely caused a very serious lack of blood flow to the hands and feet (peripheral ischemia) or to the brain, which could cause a stroke. The risk is increased when this medication is taken with other drugs that can affect the removal of dihydroergotamine from your body. Examples include azole antifungals (such as ketoconazole, itraconazole), boceprevir, cobicistat, mifepristone, telaprevir, certain antidepressants (such as nefazodone), macrolide antibiotics (such as clarithromycin, erythromycin, troleandomycin), HIV NNRTIs (such as delavirdine), HIV protease inhibitors (such as ritonavir, nelfinavir, indinavir), SSRIs (such as fluoxetine, paroxetine, fluvoxamine), among others.
| Migraine | |
| G43 | Migraine |
| G43.0 | Migraine without aura |
| G43.00 | Migraine without aura, not intractable |
| G43.001 | Migraine without aura, not intractable, with status migrainosus |
| G43.009 | Migraine without aura, not intractable, without status migrainosus |
| G43.01 | Migraine without aura, intractable |
| G43.011 | Migraine without aura, intractable, with status migrainosus |
| G43.019 | Migraine without aura, intractable, without status migrainosus |
| G43.1 | Migraine with aura |
| G43.10 | Migraine with aura, not intractable |
| G43.101 | Migraine with aura, not intractable, with status migrainosus |
| G43.109 | Migraine with aura, not intractable, without status migrainosus |
| G43.11 | Migraine with aura, intractable |
| G43.111 | Migraine with aura, intractable, with status migrainosus |
| G43.119 | Migraine with aura, intractable, without status migrainosus |
| G43.4 | Hemiplegic migraine |
| G43.40 | Hemiplegic migraine, not intractable |
| G43.41 | Hemiplegic migraine, intractable |
| G43.7 | Chronic migraine without aura |
| G43.70 | Chronic migraine without aura, not intractable |
| G43.701 | Chronic migraine without aura, not intractable, with status migrainosus |
| G43.709 | Chronic migraine without aura, not intractable, without status migrainosus |
| G43.71 | Chronic migraine without aura, intractable |
| G43.711 | Chronic migraine without aura, intractable, with status migrainosus |
| G43.719 | Chronic migraine without aura, intractable, without status migrainosus |
| G43.8 | Other migraine |
| G43.80 | Other migraine, not intractable |
| G43.801 | Other migraine, not intractable, with status migrainosus |
| G43.809 | Other migraine, not intractable, without status migrainosus |
| G43.81 | Other migraine, intractable |
| G43.811 | Other migraine, intractable, with status migrainosus |
| G43.819 | Other migraine, intractable, without status migrainosus |
| G43.82 | Menstrual migraine, not intractable |
| G43.821 | Menstrual migraine, not intractable, with status migrainosus |
| G43.829 | Menstrual migraine, not intractable, without status migrainosus |
| G43.83 | Menstrual migraine, intractable |
| G43.831 | Menstrual migraine, intractable, with status migrainosus |
| G43.839 | Menstrual migraine, intractable, without status migrainosus |
| G43.9 | Migraine, unspecified |
| G43.90 | Migraine, unspecified, not intractable |
| G43.901 | Migraine, unspecified, not intractable, with status migrainosus |
| G43.909 | Migraine, unspecified, not intractable, without status migrainosus |
| G43.91 | Migraine, unspecified, intractable |
| G43.911 | Migraine, unspecified, intractable, with status migrainosus |
| G43.919 | Migraine, unspecified, intractable, without status migrainosus |
| G43.B | Ophthalmoplegic migraine |
| G43.B0 | Ophthalmoplegic migraine, not intractable |
| G43.B1 | Ophthalmoplegic migraine, intractable |
| G43.C | Periodic headache syndromes in child or adult |
| G43.C0 | Periodic headache syndromes in child or adult, not intractable |
| G43.C1 | Periodic headache syndromes in child or adult, intractable |
| G43.D | Abdominal migraine |
| G43.D0 | Abdominal migraine, not intractable |
| G43.D1 | Abdominal migraine, intractable |
| 0-9 | A-Z |
|---|---|
| G43 | Migraine |
| G43.0 | Migraine without aura |
| G43.00 | Migraine without aura, not intractable |
| G43.001 | Migraine without aura, not intractable, with status migrainosus |
| G43.009 | Migraine without aura, not intractable, without status migrainosus |
| G43.01 | Migraine without aura, intractable |
| G43.011 | Migraine without aura, intractable, with status migrainosus |
| G43.019 | Migraine without aura, intractable, without status migrainosus |
| G43.1 | Migraine with aura |
| G43.10 | Migraine with aura, not intractable |
| G43.101 | Migraine with aura, not intractable, with status migrainosus |
| G43.109 | Migraine with aura, not intractable, without status migrainosus |
| G43.11 | Migraine with aura, intractable |
| G43.111 | Migraine with aura, intractable, with status migrainosus |
| G43.119 | Migraine with aura, intractable, without status migrainosus |
| G43.4 | Hemiplegic migraine |
| G43.40 | Hemiplegic migraine, not intractable |
| G43.41 | Hemiplegic migraine, intractable |
| G43.7 | Chronic migraine without aura |
| G43.70 | Chronic migraine without aura, not intractable |
| G43.701 | Chronic migraine without aura, not intractable, with status migrainosus |
| G43.709 | Chronic migraine without aura, not intractable, without status migrainosus |
| G43.71 | Chronic migraine without aura, intractable |
| G43.711 | Chronic migraine without aura, intractable, with status migrainosus |
| G43.719 | Chronic migraine without aura, intractable, without status migrainosus |
| G43.8 | Other migraine |
| G43.80 | Other migraine, not intractable |
| G43.801 | Other migraine, not intractable, with status migrainosus |
| G43.809 | Other migraine, not intractable, without status migrainosus |
| G43.81 | Other migraine, intractable |
| G43.811 | Other migraine, intractable, with status migrainosus |
| G43.819 | Other migraine, intractable, without status migrainosus |
| G43.82 | Menstrual migraine, not intractable |
| G43.821 | Menstrual migraine, not intractable, with status migrainosus |
| G43.829 | Menstrual migraine, not intractable, without status migrainosus |
| G43.83 | Menstrual migraine, intractable |
| G43.831 | Menstrual migraine, intractable, with status migrainosus |
| G43.839 | Menstrual migraine, intractable, without status migrainosus |
| G43.9 | Migraine, unspecified |
| G43.90 | Migraine, unspecified, not intractable |
| G43.901 | Migraine, unspecified, not intractable, with status migrainosus |
| G43.909 | Migraine, unspecified, not intractable, without status migrainosus |
| G43.91 | Migraine, unspecified, intractable |
| G43.911 | Migraine, unspecified, intractable, with status migrainosus |
| G43.919 | Migraine, unspecified, intractable, without status migrainosus |
| G43.B | Ophthalmoplegic migraine |
| G43.B0 | Ophthalmoplegic migraine, not intractable |
| G43.B1 | Ophthalmoplegic migraine, intractable |
| G43.C | Periodic headache syndromes in child or adult |
| G43.C0 | Periodic headache syndromes in child or adult, not intractable |
| G43.C1 | Periodic headache syndromes in child or adult, intractable |
| G43.D | Abdominal migraine |
| G43.D0 | Abdominal migraine, not intractable |
| G43.D1 | Abdominal migraine, intractable |
Formulary Reference Tool