Fame and Mortality: Evidence from a Retrospective Analysis of Singers
November 26, 2025
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Brand Name :
D.H.E. 45
Synonyms :
dihydroergotamine
Class :
Ergot derivatives
Brand Name :
D.H.E. 45
Synonyms :
dihydroergotamine
Class :
Ergot derivatives
Dosage forms& StrengthsÂ
Injectable solutionsÂ
1mg/mLÂ
Safety and efficacy studies are not establishedÂ
Refer adult dosingÂ
The pharmacodynamic synergism between dihydroergotamine and pseudoephedrine enhances the effects of pseudoephedrine
when both drugs are combined, there may be an increased effect of dihydroergotamine by affecting hepatic or intestinal enzyme cyp3a4 metabolism  
acrivastine and pseudoephedrineÂ
may increase the vasoconstrictive effect of alpha/beta agonists
may diminish the vasodilatory effect when combined with nitroglycerin
by affecting intestinal metabolism, the effect of dihydroergotamine may be increased
they increase the effect of vasoconstriction of alpha-1 agonists
may have an increased vasoconstricting effect when combined with ergot derivatives
may have an increased vasoconstricting effect when combined with ergot derivatives
may have an increased vasoconstricting effect when combined with ergot derivatives
may have an increased vasoconstricting effect when combined with ergot derivatives
may have an increased vasoconstricting effect when combined with ergot derivatives
may have an increased vasoconstricting effect when combined with alpha1-agonists
It may enhance the effect when combined with miconazole vaginal by affecting CYP3A4 metabolism
may have an increased vasoconstricting effect when combined with alpha1-agonists
may have an increased vasoconstricting effect when combined with alpha1-agonists
may have an increased vasoconstricting effect when combined with alpha1-agonists
may have an increased vasoconstricting effect when combined with alpha1-agonists
may have an increased vasoconstricting effect when combined with alpha1-agonists
may have an increased vasoconstricting effect when combined with dihydroergotamine
may have an increased vasoconstricting effect when combined with dihydroergotamine
may have an increased vasoconstricting effect when combined with dihydroergotamine
may have an increased vasoconstricting effect when combined with dihydroergotamine
may have an increased vasoconstricting effect when combined with dihydroergotamine
may have an increased vasoconstricting effect when combined with alpha1-agonists
may have an increased vasoconstricting effect when combined with alpha1-agonists
bunazosin (Not available in the United States)
may have an increased vasoconstricting effect when combined with alpha1-agonists
may have an increased vasoconstricting effect when combined with alpha1-agonists
may have an increased vasoconstricting effect when combined with alpha1-agonists
may have an increased vasoconstricting effect when combined with alpha1-agonists
lapatinib increases the effect of dihydroergotamine by altering the intestinal or hepatic CYP3A4 enzyme metabolism
may enhance the vasoconstricting effect of ergot Derivatives
may enhance the vasoconstricting effect of ergot Derivatives
may enhance the vasoconstricting effect of ergot Derivatives
may enhance the vasoconstricting effect of ergot Derivatives
may enhance the vasoconstricting effect of ergot Derivatives
may increase the vasoconstriction effect of sympathomimetic drugs
may increase the vasoconstriction effect of sympathomimetic drugs
may enhance the serum concentration of CYP3A4 inhibitors
may increase the levels of serum concentration of ergot derivatives
may increase the levels of serum concentration of ergot derivatives
may increase the levels of serum concentration of ergot derivatives
may increase the levels of serum concentration of ergot derivatives
may increase the levels of serum concentration of ergot derivatives
may increase the vasoconstricting effect of Serotonin 5-HT1D Receptor Agonists (Triptans)
It may diminish the effect when combined with griseofulvin by CYP3A4 metabolism
may have an increasingly adverse effect when combined with bromocriptine
may enhance the concentration of serum when combined with ergot derivatives
may have an increased vasoconstricting effect when combined with dihydroergotamine
may enhance the concentration of serum when combined with ergot derivatives
may enhance the concentration of serum when combined with ergot derivatives
may enhance the concentration of serum when combined with ergot derivatives
may enhance the concentration of serum when combined with ergot derivatives
may have an increasingly adverse effect when combined with ergot derivatives
may have an increasingly adverse effect when combined with ergot derivatives
may have an increased vasoconstricting effect when combined with methysergide
may enhance the concentration of serum when combined with ergot derivatives
ergot derivatives increase the effect of vasoconstriction of alpha beta agonists
by altering intestinal/hepatic CYP 3A4 metabolism, the activity of dihydroergotamine can be reduced by butabarbital
metronidazole/tetracycline/bismuth subsalicylateÂ
by altering the intestinal/hepatic CYP3A4 metabolism, the effects of dihydroergotamine will be increased by metronidazole
ergot Derivatives may enhance the serotonergic effect of serotonergic Agents
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may decrease the levels of serum concentration
may decrease the levels of serum concentration
may decrease the levels of serum concentration
may decrease the levels of serum concentration
may decrease the levels of serum concentration
may decrease the levels of serum concentration
may decrease the levels of serum concentration
may decrease the levels of serum concentration
may decrease the levels of serum concentration
may have an increased serotonergic effect when combined with serotonergic agents
The potential for increased CNS depression risk or seriousness occurs when dihydroergotamine is used together with pinazepam
The potential for increased CNS depression risk or seriousness occurs when dihydroergotamine is used together with pipecuronium
When dihydroergotamine is used together with bromisoval, the risk or seriousness of CNS depression is enhanced
It may diminish the metabolism when combined with Ergot alkaloids
It may diminish the metabolism when combined with Ergot alkaloids
It may diminish the metabolism when combined with Ergot alkaloids
It may diminish the metabolism when combined with Ergot alkaloids
It may diminish the metabolism when combined with Ergot alkaloids
bazedoxifene/conjugated estrogens
It may diminish the metabolism when combined with Ergot alkaloids
It may diminish the metabolism when combined with Ergot alkaloids
It may diminish the metabolism when combined with Ergot alkaloids
It may diminish the metabolism when combined with Ergot alkaloids
It may diminish the metabolism when combined with Ergot alkaloids
It may diminish the metabolism when combined with Ergot alkaloids
When dihydroergotamine is used together with medazepam, the risk or seriousness of CNS depression is enhanced
The potential for CNS depression may enhanced when dihydroergotamine is used together with fencamfamin
It may enhance the risk of adverse reactions when combined with Ergot alkaloids
It may enhance the risk of adverse reactions when combined with Ergot alkaloids
It may enhance the risk of adverse reactions when combined with Ergot alkaloids
It may enhance the risk of adverse reactions when combined with Ergot alkaloids
It may enhance the risk of adverse reactions when combined with Ergot alkaloids
When dihydroergotamine is used together with niaprazine, the risk or seriousness of CNS depression is enhanced
When dihydroergotamine is used together with melitracen, this leads to enhanced risk or seriousness of CNS depression
When dihydroergotamine is used together with oleandomycin, this leads to enhanced concentration serum of dihydroergotamine
When dihydroergotamine is used together with ridaforolimus, this leads to enhanced concentration serum of dihydroergotamine
fedratinib increases the effect of dihydroergotamine by altering the intestinal/ hepatic CYP3A4 enzyme metabolism
it may increase the effect of serotonergic agents
beta-blockers may enhance the vasoconstricting effect of ergot derivatives
beta-blockers may enhance the vasoconstricting effect of ergot derivatives
beta-blockers may enhance the vasoconstricting effect of ergot derivatives
beta-blockers may enhance the vasoconstricting effect of ergot derivatives
beta-blockers may enhance the vasoconstricting effect of ergot derivatives
may increase the vasoconstrictive effect of beta blockers
may increase the effect of ergot derivatives
may increase the vasoconstricting effect
may increase the vasoconstricting effect
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may enhance the concentration of serum when combined with ergot derivatives
may have an increased vasoconstricting effect when combined with ergot derivatives
may have an increased vasoconstricting effect when combined with ergot derivatives
may have an increased vasoconstricting effect when combined with ergot derivatives
may have an increased vasoconstricting effect when combined with ergot derivatives
may have an increased vasoconstricting effect when combined with ergot derivatives
may have an increased hypertensive effect when combined with ergot derivatives
may have an increasingly adverse effect when combined with ergot derivatives
may have an increased hypertensive effect when combined with ergot derivatives
may enhance the serum concentration of Ergot Derivatives
It may diminish the metabolism when combined with Endothelin antagonists
It may diminish the metabolism when combined with Endothelin antagonists
It may diminish the metabolism when combined with Endothelin antagonists
It may diminish the metabolism when combined with Estrogens
It may diminish the metabolism when combined with Estrogens
bazedoxifene/conjugated estrogens
It may diminish the metabolism when combined with Estrogens
It may diminish the metabolism when combined with Estrogens
It may diminish the metabolism when combined with Estrogens
It may diminish the metabolism when combined with Vasodilators
May enhances the effects of the other by pharmacodynamic synergism
Actions and spectrum:Â
ActionsÂ
Vasoconstriction: Drug is known for its very strong vasoconstrictive effect, mainly on the smooth muscles of blood vessels. It works as an agonist of 5-HT1B and 5-HT1D (serotonin receptors) in the walls of blood vessels, which results in their contraction. This vasoconstrictive effect is beneficial to ease the pain that comes with migraine and cluster headache.Â
 Anti-inflammatory effects: This drug also possesses anti-inflammatory activity via inhibition of the release of pro-inflammatory cytokines and histamines. This action may also contribute to the relief of headaches and associated symptoms.Â
Frequency not defined Â
CommonÂ
Throat irritationÂ
Nasal irritationÂ
Taste sense altered, Nasal sprayÂ
VomitingÂ
NauseaÂ
ParesthesiaÂ
DizzinessÂ
SeriousÂ
ParesthesiaÂ
Cerebrovascular diseaseÂ
TachycardiaÂ
VasospasmÂ
Peripheral ischemia (rare)Â
Black box warning Â
It is contraindicated for use in combination with CYP3A4 as this may result in potential peripheral ischemia and can pose a significant risk to life.Â
Contraindications/CautionÂ
ContraindicationsÂ
HypersensitivityÂ
Basilar or hemiplegic migraineÂ
Pregnancy Â
LactationÂ
Uncontrolled hypertensionÂ
Angina pectorisÂ
Myocardial infarctionÂ
Coronary artery vasospasmÂ
Prinzmetal’s variant anginaÂ
Concomitant administration with central and peripheral vasoconstrictorsÂ
Coadministration with CYP3A4 inhibitorsÂ
Administration of 5-HT1 agonists within one day Â
CautionsÂ
Retroperitoneal or pleural fibrosisÂ
Acute myocardial infarctionÂ
Altered cardiac rhythm that may be life-threateningÂ
Coronary artery vasospasmÂ
Should be used only if diagnosis for migraine is confirmedÂ
Raynaud’s syndromeÂ
Ischemic bowel syndromeÂ
Cerebral hemorrhageÂ
StrokeÂ
Subarachnoid hemorrhageÂ
Transient ischemic attackÂ
Pregnancy & breastfeeding:Â
Pregnancy consideration:Â
USFDA pregnancy category: Not assignedÂ
Breastfeeding warnings:Â
Data about the excretion of the drug into human milk is not knownÂ
Pregnancy category:Â
Pharmacology:Â
Dihydroergotamine is a medication which belongs to a class of drugs known as ergot alkaloids and derived from a fungus called Claviceps purpurea. It is indicated as an abortive therapy in treating migraines.Â
Pharmacodynamics:Â
Dihydroergotamine (DHE) usage is recommended for the treatment of migraine headache with or without aura. Beside cluster headache episodes, DHE has its therapeutic effects, which supposedly include nervous and vascular mechanisms. As a serotonin agonist, DHE may help decrease the activity of the neurotransmitter glutamate, which is the trigeminal system that leads to cortical spreading depression and migraines. Furthermore, its serotonin agonist activity triggers the blood vessels to narrow, which can bring about the frequent side effect of tightness of the chest, and can possibly offer therapeutic advantages through the vasodilation action produced in response to the release of calcitonin gene-related peptide (CGRP) during migraine.Â
Pharmacokinetics:Â
Absorption:Â
The bioavailability of the drug is found to be about 40% when administered intranasally. The absorption is poor in case of oral formulations due to first-pass metabolism. 100% bioavailability can be achieved when given through IV or IM.Â
Distribution:Â
The volume of distribution of the drug is found to be 800L. 93% of the drug is bound to plasma proteins.Â
Metabolism:Â
It undergoes hepatic metabolism and produces four metabolites of which 8-β-hydroxy dihydroergotamine is the active and major metabolite with potency equivalent to 5-HT and adrenergic receptors. Â
Elimination/Excretion:Â
It is eliminated primarily through biliary excretion. Less 10% of the drug is eliminated through urine and most of the drug is mainly excreted in feces.Â
Half-life: It shows biphasic elimination half-lives with 0.7 to 1 hour and 10 to 13 hours. Â
Administration:Â
It can be administered as an IM, IV, or SC injection. For IV administration, 1 mg or a smaller portion should be given over a period of 1 minute. It is important to note that this medication is not suitable for regular, long-term use.Â
Patient information leafletÂ
Generic Name: dihydroergotamineÂ
Why do we use dihydroergotamine?Â
This drug is indicated to ease migraine and cluster headaches. It is also used in treating status migrainosus. In some cases, this medication is also used to manage postpartum hemorrhage by constricting the blood vessels and reducing bleeding.Â
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