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D.h.e. 45

Generic Name: dihydroergotamine (injection) (dye HYE droe er GOT a meen)
Brand Name: D.H.E. 45
Physician reviewed D.H.E. 45 (injection) (injection) patient information - includes D.H.E. 45 (injection) description, dosage and directions.
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Drug Information:
D.H.E. 45 is in a group of drugs called ergot alkaloids (ER-got AL-ka-loids). It works by narrowing the blood vessels around the brain and affects blood flow patterns that are associated with certain types of headaches. D.H.E. 45 is used to treat a migraine or cluster headache attack. This medication will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks. D.H.E. 45 should not be used to treat common tension headaches or any headache that seems to be different from your usual migraine headaches. This medicine is not for daily use. Learn more

D.h.e. 45 Side Effects

D.H.E. 45 Side Effects

Note: This document contains side effect information about dihydroergotamine. Some of the dosage forms listed on this page may not apply to the brand name D.H.E. 45.

For the Consumer

Applies to dihydroergotamine: nasal spray


Nasal route (Solution)

Serious and/or life-threatening peripheral ischemia has been associated with the coadministration of dihydroergotamine with potent CYP3A4 inhibitors including protease inhibitors and macrolide antibiotics. Because CYP3A4 inhibition elevates the serum levels of dihydroergotamine, the risk for vasospasm leading to cerebral ischemia and/or ischemia of the extremities is increased. Hence, concomitant use of these medications is contraindicated.

Along with its needed effects, dihydroergotamine (the active ingredient contained in D.H.E. 45) 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 as soon as possible if any of the following side effects occur while taking dihydroergotamine:

Less common or rare

  • Chest pain
  • cough, fever, sneezing, or sore throat
  • feeling of heaviness in chest
  • irregular heartbeat
  • itching of the skin
  • numbness and tingling of face, fingers, or toes
  • pain in arms, legs, or lower back
  • pain in back, chest or left arm
  • pale bluish-colored or cold hands or feet
  • shortness of breath or troubled breathing
  • weak or absent pulses in legs

Symptoms of overdose

  • Confusion
  • convulsions (seizures)
  • delirium
  • dizziness
  • headaches
  • nausea and/or vomiting
  • numbness, tingling, and/or pain in the legs or arms
  • shortness of breath
  • stomach pain

Some side effects of dihydroergotamine 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:

More common

  • Burning or tingling sensation, dryness, soreness, or pain in the nose
  • change in sense of taste
  • diarrhea
  • dizziness
  • dry mouth
  • fatigue
  • headache
  • increased sweating
  • nausea and or vomiting
  • muscle stiffness
  • runny and or stuffy nose
  • sudden sweatings and feelings of warmth
  • sensation of burning, warmth, or heat
  • sore throat
  • sleepiness
  • unexplained nose bleeds
  • unusual tiredness or weakness

Less common

  • Anxiety
  • blurred vision
  • cold clammy skin
  • confusion
  • congestion in chest
  • cough
  • decreased appetite
  • depression
  • difficulty swallowing
  • dizziness or lightheadedness when getting up from a lying or sitting position
  • ear pain
  • eye pain
  • fever
  • heartburn
  • increased watering of eyes
  • increased watering of the mouth
  • increased yawning
  • muscle weakness
  • nervousness
  • pinpoint red spots on skin
  • pounding heartbeat
  • red or irritated eyes
  • ringing or buzzing in ears
  • skin rash
  • stomach pain
  • sudden fainting
  • swelling of face, fingers, feet, or lower legs
  • trembling or shaking of hands or feet
  • trouble in sleeping
  • unusual feeling of well being

For Healthcare Professionals

Applies to dihydroergotamine: injectable solution, nasal spray


The most commonly reported adverse events have included nausea and vomiting; with use of the nasal spray, rhinitis, altered sense of taste, and application site reactions have also been reported.


Deaths due to cardiac events have been reported with parenteral use, but no cardiac related deaths were reported during clinical studies with the nasal spray. Reports of serious cardiac events with the injection appear to be rare.

Uncommon (0.1% to 1%): Edema, palpitation, tachycardia

Rare (less than 0.1%): Hypotension, peripheral ischemia, angina, cardiac valvular fibrosis

Frequency not reported: Acute myocardial infarction, transient myocardial ischemia, ventricular tachycardia, ventricular fibrillation, coronary artery vasospasm, bradycardia, extrasystoles, intermittent claudication, Raynaud's phenomenon

Postmarketing reports: Vasospasm, hypertension, flushing, peripheral ischemia, gangrene

Nervous system

Common (1% to 10%): Dizziness, somnolence, paraesthesia

Uncommon (0.1% to 1%): Tremor, hypoesthesia, altered sense of smell

Rare (less than 0.1%): Speech disorder, hyperkinesia, stupor, abnormal gait, depression, aggravated migraine, convulsions

Frequency not reported: Cerebral hemorrhage, subarachnoid hemorrhage, stroke, headache


Almost 30% of patients receiving the nasal spray reported irritation in the nose, throat, and/or disturbances in taste. Symptoms of congestion, burning, dryness, paraesthesia, discharge, epistaxis, pain, and soreness, mostly mild to moderate and transient, have been reported. In most (approximately 70%), symptoms resolved within 4 hours. The consequence of extended and repeated use on the nasal mucosa have not been studied.

Very common (10% or more): Local irritation (nasal spray; 30%)

Common (1% to 10%): Application site reactions

Uncommon (0.1% to 1%): Local anesthesia


Very common (10% or more): Rhinitis (nasal spray; 26%)

Common (1% to 10%): Pharyngitis, sinusitis

Uncommon (0.1% to 1%): Dyspnea, upper respiratory tract infections

Rare (less than 0.1%): Bronchospasm, bronchitis, pleural pain, epistaxis, yawning

Postmarketing reports: Pleural fibrosis


Common (1% to 10%): Nausea, vomiting, diarrhea

Uncommon (0.1% to 1%): Abdominal pain, dyspepsia, hiccup, dry mouth

Rare (less than 0.1%): Increased salivation, esophagospasm, anorexia

Frequency not reported: Colonic ischemia

Postmarketing reports: Retroperitoneal fibrosis

The most frequent side effect with the use of intravenous dihydroergotamine is nausea. Following intramuscular or intranasal administration, the incidence of nausea is lower.


Uncommon (0.1% to 1%): Vertigo, tinnitus, earache, feeling cold, malaise, rigors, fever, fatigue, asthenia


Common (1% to 10%): Stiffness

Uncommon (0.1% to 1%): Cramps, myalgia, muscular weakness, dystonia

Rare (Less than 0.1%): Arthralgia, involuntary muscle contractions, rigidity

Frequency not reported: Leg pain, muscle spasms


Frequency not reported: Renal artery spasm


Frequency not reported: Hypersensitivity reactions such as skin rash, face edema, urticaria, and dyspnea


Uncommon (0.1% to 1%): Photophobia, conjunctivitis, abnormal lacrimation, abnormal vision, periorbital edema

Rare (less than 0.1%): Eye pain


Uncommon (0.1% to 1%): Nervousness, euphoria, insomnia, impaired concentration

Rare (less than 0.1%): Anxiety


Uncommon (0.1% to 1%): Petechia, pruritus, rash, cold clammy skin

Rare (less than 0.1%): Papular rash, urticaria, herpes simplex

Frequency not reported: Sweating


Uncommon (0.1% to 1%): Increased micturition frequency, cystitis

Rare (less than 0.1%): Pelvic inflammation, vaginitis

Editorial References and Review

Medically reviewed by BestRx Medical Team Last updated on 1/1/2020.

Source: Drugs.com D.h.e. 45