Dihydroergotamine: uses, dosing, side effects & brands
Dihydroergotamine is an ergotamine derivative sold in the U.S. under 6 brand and generic names, for cluster headache, postpartum hemorrhage and orthostatic hypotension. Below: what the FDA label says, every product that contains it, what the pills look like, and its recall record.
Key facts
- Drug class
- Ergotamine Derivative
- Treats (across its forms)
- Cluster Headache, Postpartum Hemorrhage and Orthostatic Hypotension
- Available as
- Injectable · Powder · Solution · Spray/Inhaler · Spray/Inhaler, metered
- Sold as
- 6 products — Brekiya (Autoinjector), Atzumi and D.H.E. 45, and others
- Prescription?
- Prescription only
- Generic available?
- Yes
- Half-life
- about 9 to 13 hours, depending on the form
- What the pharmacy pays
- about $35 per ml — not your price
- Boxed warning
- Boxed warning
How Brekiya (Autoinjector) is dosed
From the FDA label for Brekiya (Autoinjector) (application NDA215400). Other dihydroergotamine products — different forms, different strengths — are dosed differently. Follow the label for the one you were prescribed.
For subcutaneous injection only. ( 2.1 ) Recommended dosage is 1 mg administered subcutaneously as a single 1 mL autoinjector. ( 2.1 ) Do not exceed 3 mg (3 doses) in a 24-hour period. ( 2.1 ) Do not exceed 6 mg (6 doses) in a week. ( 2.1 ) Prior to initiation, a cardiovascular evaluation is recommended. ( 2.2 ) 2.1 Recommended Dosage BREKIYA autoinjector is for subcutaneous injection only. The recommended dose of BREKIYA is 1 mg administered subcutaneously via a single 1 mL autoinjector. The dose may be repeated, as needed, at 1-hour intervals to a total maximum of 3 mg (3 doses) in a 24-hour period. Do not exceed 6 mg (6 doses) total in a week. 2.2 Assessment Prior to First Dose Prior to initiation of BREKIYA, a cardiovascular evaluation is recommended [see Warnings and Precautions (5.3) ] . For patients with risk factors predictive of coronary artery disease who are determined to have a satisfactory cardiovascular evaluation, it is strongly recommended that administration of the first dose of BREKIYA take place in the setting of an equipped healthcare facility. 2.3 Important Administration Instructions See the “Instructions for Use” for detailed steps for administering the subcutaneous injection using the autoinjector. Preparation BREKIYA is a prefilled, single-dose disposable autoinjector intended to be given subcutaneously into the skin of the middle thigh. Rotate…
Everything below is the FDA label for Brekiya (Autoinjector) (injectable). Dihydroergotamine is also sold as powder, solution, spray/inhaler and spray/inhaler, metered, and those are different medicines to take — follow the label for the one you were prescribed.
Brekiya (Autoinjector) side effects
The following clinically significant adverse reactions are described elsewhere in the labeling: Peripheral Ischemia Following Coadministration with Strong CYP3A4 Inhibitors [see Boxed Warning and Warnings and Precautions (5.1) ] Myocardial Ischemia and/or Infarction, Other Cardiac Adverse Reactions, and Fatalities [see Warnings and Precautions (5.2) ] Cerebrovascular Adverse Reactions and Fatalities [see Warnings and Precautions (5.3) ] Other Vasospasm Related Adverse Reactions [see Warnings and Precautions (5.4) ] Increase in Blood Pressure [see Warnings and Precautions (5.5) ] Medication Overuse Headache [see Warnings and Precautions (5.6) ] Preterm Labor [see Warnings and Precautions (5.7) ] Fibrotic Complications [see Warnings and Precautions (5.8) ] Hypersensitivity [see Warnings and Precautions (5.9) ] The following adverse reactions associated with the use of dihydroergotamine were identified in clinical studies or postmarketing reports. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to the drug exposure. Serious cardiac events, including some that have been fatal, have occurred following use of dihydroergotamine. Events reported have included coronary artery vasospasm, transient myocardial ischemia, myocardial infarction, ventricular…
Who shouldn’t take Brekiya (Autoinjector)
BREKIYA is contraindicated in patients: with concomitant use of strong CYP3A4 inhibitors [see Warnings and Precautions (5.1) and Drug Interactions (7.1) ] with ischemic heart disease (e.g., angina pectoris, history of myocardial infarction, or documented silent ischemia) or patients who have clinical symptoms or findings consistent with coronary artery vasospasm, including Prinzmetal's variant angina [see Warnings and Precautions (5.4) ] with uncontrolled hypertension [see Warnings and Precautions (5.5) ] with peripheral arterial disease with sepsis following vascular surgery with severe hepatic impairment with severe renal impairment with known hypersensitivity to dihydroergotamine, ergot alkaloids, latex, or any of the ingredients in BREKIYA [see Warnings and Precautions (5.9) ] with recent use (i.e., within 24 hours) of other 5-HT 1 agonists, ergotamine-containing or ergot-type medications [see Drug Interactions (7.2) ] with concomitant use of peripheral and central vasoconstrictors because the combination may result in additive or synergistic elevation of blood pressure [see Warnings and Precautions (5.5) ] Concomitant use of strong CYP3A4 inhibitors ( 4 ) Ischemic heart disease or coronary artery vasospasm ( 4 ) Uncontrolled hypertension, peripheral arterial diseases, sepsis, following vascular surgery, or severe hepatic or renal impairment ( 4 ) Concomitant use of other 5-HT 1 agonists or ergotamine-containing or ergot-type medications within 24 hours ( 4 ) Hypersensitivity to dihydroergotamine, ergot alkaloids, latex, or any of the ingredients in BREKIYA (4) Concomitant use with peripheral and central vasoconstrictors ( 4 )
Brekiya (Autoinjector) drug interactions
Beta Blockers/Nicotine: May potentiate/provoke vasoconstriction. ( 7.3 , 7.5 ) Selective Serotonin Reuptake Inhibitors: Weakness, hyperreflexia, and incoordination may occur with coadministration. ( 7.6 ) 7.1 CYP3A4 Inhibitors There have been rare reports of serious adverse events in connection with the coadministration of intravenous administration of dihydroergotamine and strong CYP3A4 inhibitors resulting in vasospasm that led to cerebral ischemia and/or ischemia of the extremities [see Warnings and Precautions (5.1) ]. The use of strong CYP3A4 inhibitors with BREKIYA is contraindicated [see Contraindications (4) ]. Administer moderate CYP3A4 inhibitors with caution. 7.2 Triptans Triptans (serotonin [5-HT 1B/1D receptor agonists) have been reported to cause coronary artery vasospasm, and its effect could be additive with BREKIYA. Therefore, triptans and BREKIYA should not be taken within 24 hours of each other [see Contraindications (4) ]. 7.3 Beta Blockers There have been reports that propranolol may potentiate the vasoconstrictive action of ergotamine by blocking the vasodilating property of epinephrine. 7.4 Vasoconstrictors BREKIYA is contraindicated for use with peripheral and central vasoconstrictors because the combination may cause synergistic elevation of blood pressure [see Warnings and Precautions (5.5) ]. 7.5 Nicotine Nicotine may provoke vasoconstriction in some patients, predisposing to a greater ischemic response to ergot therapy [see Warnings and Precautions (5.4) ] . 7.6 Selective Serotonin Reuptake Inhibitors Weakness, hyperreflexia, and incoordination have been reported rarely when 5-HT 1 agonists have been co-administered with selective serotonin reuptake inhibitors (SSRI’s) (e.g., fluoxetine, fluvoxamine, paroxetine, sertraline).
Every dihydroergotamine product we track (6)
Same active ingredient — different manufacturer, form, price and FDA recall record. That last one is what our independent score measures.
| # | Drug | Rating | Type | Form | Generic? | Pharmacy pays | |
|---|---|---|---|---|---|---|---|
| 1 | 70/100 | Prescription | Injectable | Generic | $35 | View → | |
| 2 | Not yet rated | Prescription | Powder | Generic | $35 | View → | |
| 3 | Not yet rated | Prescription | Injectable | Generic | $35 | View → | |
| 4 | Not yet rated | Prescription | Injectable | Generic | $35 | View → | |
| 5 | Not yet rated | Prescription | Spray/Inhaler | Generic | $35 | View → | |
| 6 | Not yet rated | Prescription | Spray/Inhaler | Generic | $35 | View → |
Combination products containing dihydroergotamine
A combination is a different drug — different dosing, different warnings. It is listed here so you can find it, not so you can substitute it.
Dihydroergotamine recalls
From the FDA Enforcement database. A recall covers specific lots — not the drug as a whole.
How long dihydroergotamine keeps
The date on a sealed pack is not the only one: some dihydroergotamine labels start a second clock once the product is opened or mixed, as short as 8 hours.
Does dihydroergotamine expire? The in-use limits and storage rules from its labelsWhat people report to the FDA about dihydroergotamine
The FDA Adverse Event Reporting System (FAERS) collects reports from patients and clinicians. It holds 744 reports naming dihydroergotamine, and the FDA flagged 82% of those reports as serious. The effects reported most often — leaving out reports about overdose, misuse or the condition being treated, which dominate the raw list for common medicines:
- hyperhidrosis296 reports
- nightmare282 reports
- sedation282 reports
- nausea274 reports
- nephrolithiasis193 reports
- migraine79 reports
- treatment failure57 reports
- dyspnoea51 reports
Read these as a signal, not a rate. A report does not mean dihydroergotamine caused the effect — anyone can file one, and many describe people taking several medicines for several conditions. Crucially there is no denominator: FAERS does not record how many people took the drug, so these counts cannot be turned into “X% of patients” — a bigger number often just means a more widely used or more talked-about drug. Duplicates exist, and publicity drives reporting. For what is actually established, read the FDA label section above.
Source: openFDA drug/event (FAERS), retrieved July 25, 2026.
How long dihydroergotamine stays in your system
The elimination half-life of dihydroergotamine is about 9 to 13 hours, depending on the form. The injection label states a terminal half-life of about 9 hours after intramuscular or intravenous dosing, with a multi-exponential decline. Nasal forms read slightly longer because absorption is slower: the nasal spray label gives about 10 hours (biphasic decline) and the Atzumi nasal powder label gives an apparent half-life of about 13 hours. The major metabolite, 8'-beta-hydroxydihydroergotamine, binds adrenergic and 5-HT receptors as strongly as the parent drug and is equally potent at constricting veins, so its effects can outlast what the parent's half-life suggests — but the label explicitly says its pharmacokinetics have not been quantified, so no metabolite half-life exists in the labeling. No studies have been done on how kidney or liver impairment, age, sex, or race change these numbers; the drug is contraindicated outright in severe hepatic or renal impairment. Clearance is 1.5 L/min and mainly hepatic (excreted in bile and feces; only 6-7% of unchanged drug appears in urine), so liver disease and CYP3A4 inhibitors such as ritonavir, clarithromycin, and erythromycin are the real-world drivers of accumulation. There is no extended-release dihydroergotamine.
Dihydroergotamine Mesylate Injection, USP — FDA label, Clinical Pharmacology (DailyMed) ↗Half-life is how long the body takes to clear half a dose. It is not the same as how long a drug test can detect it, and it varies with age, kidney and liver function.
Related calculators
Frequently asked questions
What is Brekiya (Autoinjector)?
BREKIYA (dihydroergotamine mesylate) injection is an ergotamine derivative. Dihydroergotamine mesylate is a white or almost white, crystalline powder. It is slightly soluble in water and chloroform and sparingly soluble in methanol.
What kind of drug is dihydroergotamine?
The FDA classifies dihydroergotamine as an ergotamine derivative. If you are checking whether it is safe to combine with something else, the class is what matters — two drugs from the same class usually should not be stacked.
How long does dihydroergotamine stay in your system?
The elimination half-life of dihydroergotamine is about 9 to 13 hours, depending on the form — that is how long the body takes to clear half of a dose. The injection label states a terminal half-life of about 9 hours after intramuscular or intravenous dosing, with a multi-exponential decline. Nasal forms read slightly longer because absorption is slower: the nasal spray label gives about 10 hours (biphasic decline) and the Atzumi nasal powder label gives an apparent half-life of about 13 hours. The major metabolite, 8'-beta-hydroxydihydroergotamine, binds adrenergic and 5-HT receptors as strongly as the parent drug and is equally potent at constricting veins, so its effects can outlast what the parent's half-life suggests — but the label explicitly says its pharmacokinetics have not been quantified, so no metabolite half-life exists in the labeling. No studies have been done on how kidney or liver impairment, age, sex, or race change these numbers; the drug is contraindicated outright in severe hepatic or renal impairment. Clearance is 1.5 L/min and mainly hepatic (excreted in bile and feces; only 6-7% of unchanged drug appears in urine), so liver disease and CYP3A4 inhibitors such as ritonavir, clarithromycin, and erythromycin are the real-world drivers of accumulation. There is no extended-release dihydroergotamine. Half-life is not the same as how long a drug test can detect the drug, and it varies with age, kidney and liver function.
Can you take dihydroergotamine with other medicines?
It depends on the medicine. We check it against the FDA labels rather than guessing: our interaction checker searches each drug's own label for the other and quotes what it says, naming the section it came from. Run dihydroergotamine against whatever else you take — and remember that a label not naming a drug is not the same as that combination being safe.
What brand names is dihydroergotamine sold under?
We track 6 dihydroergotamine-containing products in the U.S.: Brekiya (Autoinjector), Atzumi, D.H.E. 45, Dihydroergotamine Mesylate, Migranal and Trudhesa. They are the same active ingredient; they differ in form, manufacturer, price and FDA recall record.
What forms does dihydroergotamine come in?
Across the brands we track, dihydroergotamine is currently marketed as injectable, powder, solution, spray/inhaler and spray/inhaler, metered, per the FDA's National Drug Code Directory. Each form is dosed differently — follow the label for the exact product you were prescribed.
Is there a generic dihydroergotamine?
Yes. Our catalog lists 1 generic dihydroergotamine product alongside the brand versions. A generic has the same active ingredient and must meet the FDA's bioequivalence standard; it usually costs less. Ask your pharmacist which one your plan covers.
Has dihydroergotamine been recalled?
The FDA's Enforcement database lists 1 recall record whose product description mentions dihydroergotamine. The most recent: Dihydroergotamine Mesylate Injection (Nov 22, 2024). A recall applies to specific lots, not to the drug as a whole — check the record for the affected lot numbers.
Cite this page
- APA
- pharmaranks. (2026, July 24). Dihydroergotamine: uses, dosing, side effects & brands. https://pharmaranks.com/drugs/dihydroergotamine
- MLA
- “Dihydroergotamine: uses, dosing, side effects & brands.” pharmaranks, 24 July 2026, https://pharmaranks.com/drugs/dihydroergotamine.
We summarise public FDA and NIH sources — for a clinical claim, cite the primary source we link to as well.
Sources: FDA openFDA drug label, National Drug Code Directory, and Enforcement (recall) database. This page reproduces public FDA data and is not medical advice. Dosing is set by your prescriber.
Read the full FDA label for dihydroergotamine on DailyMed (NIH) ↗ — including its boxed warning in full.