Dihydroergotamine and ergotamine belong to the group of medicines known as ergot alkaloids. They are used to treat severe, throbbing headaches, such as migraine and cluster headaches. Dihydroergotamine and ergotamine are not ordinary pain relievers. They will not relieve any kind of pain other than throbbing headaches. Because these medicines can cause serious side effects, they are usually used for patients whose headaches are not relieved by acetaminophen, aspirin, or other pain relievers.
Dihydroergotamine and ergotamine may cause blood vessels in the body to constrict (become narrower). This effect can lead to serious side effects that are caused by a decrease in the flow of blood (blood circulation) to many parts of the body.
The caffeine present in many ergotamine-containing combinations helps ergotamine work better and faster by causing more of it to be quickly absorbed into the body. The belladonna alkaloids, dimenhydrinate, and diphenhydramine in some combinations help to relieve nausea and vomiting, which often occur together with the headaches. Dimenhydrinate, diphenhydramine, and pentobarbital also help the patient relax and even sleep. This also helps relieve headaches.
Dihydroergotamine is also used for other conditions, as determined by your doctor.
These medicines are available only with your doctor's prescription.
Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, dihydroergotamine is used in certain patients with the following medical conditions:
For patients using this medicine to prevent or treat low blood pressure:
Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
For dihydroergotamine and ergotamine: These medicines are used to relieve severe, throbbing headaches in children 6 years of age or older. They have not been shown to cause different side effects or problems in children than they do in adults. However, these medicines can cause serious side effects in any patient. Therefore, it is especially important that you discuss with the child's doctor the good that this medicine may do as well as the risks of using it.
For belladonna alkaloids: Young children, especially children with spastic paralysis or brain damage, may be especially sensitive to the effects of belladonna alkaloids. This may increase the chance of side effects during treatment.
For dimenhydrinate, diphenhydramine, and pentobarbital: Although these medicines often cause drowsiness, some children become excited after taking them.
For dihydroergotamine and ergotamine: The chance of serious side effects caused by decreases in blood flow is increased in elderly people receiving these medicines.
For belladonna alkaloids, dimenhydrinate, diphenhydramine, and pentobarbital: Elderly people are more sensitive than younger adults to the effects of these medicines. This may increase the chance of side effects such as excitement, depression, dizziness, drowsiness, and confusion.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Many medicines can add to or decrease the effects of the belladonna alkaloids, caffeine, dimenhydrinate, diphenhydramine, or pentobarbital present in some of these headache medicines. Therefore, you should tell your health care professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine. This is especially important if any medicine you take causes excitement, trouble in sleeping, dryness of the mouth, dizziness, or drowsiness.
Use of dihydroergotamine or ergotamine by pregnant women may cause serious harm, including death of the fetus and miscarriage. Therefore, these medicines should not be used during pregnancy.
For dihydroergotamine and ergotamine: These medicines pass into the breast milk and may cause unwanted effects, such as vomiting, diarrhea, weak pulse, changes in blood pressure, or convulsions (seizures) in nursing babies. Large amounts of these medicines may also decrease the flow of breast milk.
For caffeine: Caffeine passes into the breast milk. Large amounts of it may cause the baby to appear jittery or to have trouble in sleeping.
For belladonna alkaloids, dimenhydrinate, and diphenhydramine: These medicines have drying effects. Therefore, it is possible that they may reduce the amount of breast milk in some people. Dimenhydrinate passes into the breast milk.
For pentobarbital: Pentobarbital passes into the breast milk. Large amounts of it may cause unwanted effects such as drowsiness in nursing babies.
Be sure that you discuss these possible problems with your doctor before taking any of these medicines.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.
Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Using medicines in this class with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use your medicine, or give you special instructions about the use of food, alcohol, or tobacco.
Other medical problems
The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:
Also, tell your doctor if you need, or if you have recently had, an angioplasty (a procedure done to improve the flow of blood in a blocked blood vessel) or surgery on a blood vessel. The chance of serious side effects caused by dihydroergotamine or ergotamine may be increased.
Use this medicine only as directed by your doctor. Do not use more of it, and do not use it more often, than directed. If the amount you are to use does not relieve your headache, check with your doctor. Taking too much dihydroergotamine or ergotamine, or taking it too often, may cause serious effects, especially in elderly patients. Also, if a headache medicine (especially ergotamine) is used too often for migraines, it may lose its effectiveness or even cause a type of physical dependence. If this occurs, your headaches may actually get worse
This medicine works best if you:
Your doctor may direct you to take another medicine to help prevent headaches. It is important that you follow your doctor's directions, even if your headaches continue to occur. Headache-preventing medicines may take several weeks to start working. Even after they do start working, your headaches may not go away completely. However, your headaches should occur less often, and they should be less severe and easier to relieve. This can reduce the amount of dihydroergotamine, ergotamine, or pain relievers that you need. If you do not notice any improvement after several weeks of headache-preventing treatment, check with your doctor.
For patients using dihydroergotamine:
For patients using the sublingual (under-the-tongue) tablets of ergotamine:
For patients using rectal suppository forms of a headache medicine:
The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
Keep out of the reach of children.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Do not keep outdated medicine or medicine no longer needed.
Suppositories should be stored in a cool place, but not allowed to freeze. Some manufacturers recommend keeping them in a refrigerator; others do not. Follow the directions on the package. However, cutting the suppository into smaller pieces, if you need to do so, will be easier if the suppository is kept in the refrigerator.
Check with your doctor:
Drinking alcoholic beverages can make headaches worse or cause new headaches to occur. People who suffer from severe headaches should probably avoid alcoholic beverages, especially during a headache.
Smoking or nicotine replacement therapy products may increase some of the harmful effects of dihydroergotamine or ergotamine. It is best to avoid smoking or the use of nicotine replacement therapy products for several hours after taking these medicines.
Dihydroergotamine and ergotamine may make you more sensitive to cold temperatures, especially if you have blood circulation problems. They tend to decrease blood flow in the skin, fingers, and toes. Dress warmly during cold weather and be careful during prolonged exposure to cold temperatures. This is especially important for older patients, who are more likely than younger adults to already have problems with their circulation.
If you have a serious infection or illness of any kind, check with your doctor before using this medicine, since you may be more sensitive to its effects.
For patients taking one of the combination medicines that contains caffeine:
Caffeine may also interfere with some other laboratory tests. Before having any other laboratory tests, tell the person in charge if you have taken a medicine that contains caffeine.
For patients taking one of the combination medicines that contains belladonna alkaloids, dimenhydrinate, diphenhydramine, or pentobarbital:
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if the following side effects occur, because they may mean that you are developing a problem with blood circulation:
Get emergency help immediately if any of the following symptoms of overdose occur:
The following side effects may go away after a little while. Do not take any more medicine while they are present. If any of them occur together with other signs of problems with blood circulation, check with your doctor right away. Even if any of the following side effects occur without other signs of problems with blood circulation, check with your doctor if any of them continue for more than one hour:
Check with your doctor as soon as possible if any of the following side effects occur:
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
After you stop taking this medicine, your body may need time to adjust. The length of time this takes depends on the amount of medicine you were taking and how long you took it. During this time check with your doctor if your headaches begin again or worsen.
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.