What is dihydroergotamine?

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. The chemical name for dihydroergotamine mesylate is ergotaman-3´,6´,18-trione,9,10-dihydro-12´-hydroxy-2´-methyl-5´-(phenylmethyl) monomethanesulfonate (salt). Its molecular weight is 679.8g/mol and its molecular formula is C 33 H 37 N 5 O 5 ∙CH 4 O 3 S. The chemical structure is BREKIYA is a clear, colorless, sterile solution supplied in 1 mL single-dose autoinjector for subcutaneous administration. Each mL contains 1 mg dihydroergotamine mesylate, USP (equivalent to 0.86 mg of dihydroergotamine). BREKIYA also contains ethanol, USP 6.1% by volume; glycerin, USP 15% by weight; water for injection, USP; may contain methanesulfonic acid and/or sodium hydroxide, NF for pH adjustment. pH range is 3.4 to 4.9. 1

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.

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.

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.

By the pharmaranks editorial teamReviewed against the FDA (openFDA label, NDC Directory & Enforcement) sourcesHow we research

Key facts

Drug class: Ergotamine Derivative
Treats: 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
Typical price: about $35 for a 30-count supply
Boxed warning: Boxed warning

How dihydroergotamine 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…

Dihydroergotamine 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…

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.

Dihydroergotamine products
#	Drug	Rating	Type	Form	Generic?	Typical price
1	Brekiya (Autoinjector)Boxed warning	70/100	Prescription	Injectable	Generic	$35	View →
2

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.

Embolex

Dihydroergotamine recalls

From the FDA Enforcement database. A recall covers specific lots — not the drug as a whole.

Dihydroergotamine Mesylate Injection
Discoloration
Provepharm Inc. · Nov 22, 2024

Frequently asked questions

What is dihydroergotamine?: 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. The chemical name for dihydroergotamine mesylate is ergotaman-3´,6´,18-trione,9,10-dihydro-12´-hydroxy-2´-methyl-5´-(phenylmethyl) monomethanesulfonate (salt). Its molecular weight is 679.8g/mol and its molecular formula is C 33 H 37 N 5 O 5 ∙CH 4 O 3 S. The chemical structure is BREKIYA is a clear, colorless, sterile solution supplied in 1 mL single-dose autoinjector for subcutaneous administration. Each mL contains 1 mg dihydroergotamine mesylate, USP (equivalent to 0.86 mg of dihydroergotamine). BREKIYA also contains ethanol, USP 6.1% by volume; glycerin, USP 15% by weight; water for injection, USP; may contain methanesulfonic acid and/or sodium hydroxide, NF for pH adjustment. pH range is 3.4 to 4.9. 1
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.
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.

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.