Home Drug Guide Dihydroergotamine

Drug Guide

Generic Name

Dihydroergotamine

Brand Names Atzumi

Classification

Therapeutic: Vasoconstrictor, antimigraine agent

Pharmacological: Ergot alkaloid

FDA Approved Indications

  • Migraine with or without aura
  • Cluster headaches

Mechanism of Action

Dihydroergotamine is a potent vasoconstrictor that acts on alpha-adrenergic and serotonin receptor sites, leading to vasoconstriction of cranial blood vessels and reduction of neurogenic inflammation involved in migraines.

Dosage and Administration

Adult: The typical dose is 1 mg administered intravenously, intramuscularly, or subcutaneously at the onset of migraine. Repeat every hour as needed, up to 2 mg in 24 hours.

Pediatric: Use is generally not recommended in children due to limited data.

Geriatric: Use with caution; start at lower doses due to increased risk of vasoconstriction and blood flow issues.

Renal Impairment: Adjust dosage and monitor closely, as renal impairment can prolong drug effects.

Hepatic Impairment: Use with caution; hepatic metabolism may be impaired, increasing drug levels.

Pharmacokinetics

Absorption: Poor oral absorption; administered parenterally or intranasally.

Distribution: Widely distributed; crosses the blood-brain barrier.

Metabolism: Primarily hepatic via CYP3A4 enzyme system.

Excretion: Metabolites excreted in bile and urine.

Half Life: Approximately 2 hours.

Contraindications

  • History of coronary artery disease, peripheral vascular disease, hypertension, or liver disease.
  • Pregnancy (category X), lactation.

Precautions

  • Use with caution in patients with risk factors for vasospasm, ischemic heart disease, or cerebrovascular disease. Monitor blood pressure and circulatory status during therapy.

Adverse Reactions - Common

  • Nausea, vomiting (Common)
  • Vasoconstriction leading to cold extremities, hypertension (Common)

Adverse Reactions - Serious

  • Ischemic events (e.g., myocardial infarction, stroke) (Serious (rare but severe))
  • Vasospasm leading to gangrene (Rare)

Drug-Drug Interactions

  • Inhibitors of CYP3A4 (e.g., macrolide antibiotics, azole antifungals, protease inhibitors) due to increased risk of ergotism.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of vasospasm, ischemia, blood pressure changes, and adverse reactions.

Diagnoses:

  • Risk for decreased cardiac output related to vasoconstriction.

Implementation: Administer as prescribed, monitor vital signs, and assess for adverse effects.

Evaluation: Effectiveness in reducing migraine symptoms and absence of adverse reactions.

Patient/Family Teaching

  • Do not use in pregnancy or breastfeeding.
  • Report any signs of cold extremities, pain, numbness, or unusual skin color changes.
  • Avoid concurrent use of other vasoconstrictive agents.

Special Considerations

Black Box Warnings:

  • Risks of vasoconstriction may lead to ischemia and gangrene.
  • Use caution with CYP3A4 inhibitors.

Genetic Factors: Genetic variations in CYP3A4 may affect metabolism.

Lab Test Interference: May affect blood pressure monitoring and vascular assessments.

Overdose Management

Signs/Symptoms: Severe vasoconstriction, ischemia, hypertension.

Treatment: Discontinue drug, provide supportive care, administer vasodilators if indicated, and implement measures to improve circulation.

Storage and Handling

Storage: Store at room temperature away from light and moisture.

Stability: Stable for the duration of labeled expiration date.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.