DIHYDROERGOTAMINE MESYLATE (Generic for MIGRANAL)

Dihydroergotamine Mesylate 4mg/1mL, Nasal spray, solution

Grapefruit juice

· Severity: Major

· Notes for Consumers: Taking grapefruit juice with Dihydroergotamine might increase the risk of nausea, nervousness, chest pain, high blood pressure, palpitations, or other serious side effects, like pain, numbness or reduced circulation to the hands, feet or legs.Use caution by not changing the amount of grapefruit juice you drink while taking Dihydroergotamine.

· Notes for Professionals: The risk of ergot toxicity (e.g., vasospasm leading to cerebral ischemia, peripheral ischemia and/or other serious effects) is potentially increased by the use of CYP3A4 inhibitors. Grapefruit juice may decrease dihydroergotamine metabolism via CYP3A4. Patients should probably use caution with grapefruit juice by not modifying their usual grapefruit juice intake while taking dihydroergotamine. Elderly patients have the greatest possibility of ingesting grapefruit and interacting medications and are the most vulnerable to the adverse clinical consequences. Grapefruit juice inhibits the cytochrome P-450 3A4 isozyme in the gut wall. Grapefruit juice contains furanocoumarins that are metabolized by CYP3A4 to reactive intermediates. These intermediates form a covalent bond to the active site of the CYP3A4 enzyme, causing irreversible inactivation (mechanism-based inhibition). Consequently, CYP3A4 activity in the gut wall is inhibited until de novo synthesis returns the enzyme to its previous level.

Dihydroergotamine Mesylate 4mg/1mL, Nasal spray, solution

Tobacco

· Severity: Major

· Notes for Consumers: It is recommended to avoid nicotine (examples: Nicotine patches or gum) and tobacco while taking any Ergot-type medications. Side effects from Ergot Alkaloids may get worse if you take Nicotine or if you smoke tobacco. Side effects might include anxiety, chest pain, numbness in the fingers or toes, tingling, or vision changes.

· Notes for Professionals: Concurrent use of vasoconstrictors, such as nicotine, with ergot alkaloids may result in enhanced vasoconstriction. Nicotine acts indirectly as a sympathomimetic agent by releasing catecholamines, potentially resulting in effects such as hypertension, coronary spasm, coronary ischemia, or cardiac arrhythmias, which may be additive with ergot alkaloids. Patients should avoid smoking tobacco or using other nicotine-containing products while taking ergot compounds if possible.

<b>DISCLAIMER:</b><em> This drug information content is provided for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Patients should always consult their physician with any questions regarding a medical condition and to obtain medical advice and treatment. Drug information is sourced from GSDD (Gold Standard Drug Database ) provided by Elsevier.</em>