Parenteral Manual

Dihydroergotamine Mesylate

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Alpha-Adrenergic Blocking Agent, Antimigraine Agent, Ergot Alkaloid
Original Date: 
May 2017
  • Treatment of headache with or without aura and cluster headaches
Reconstitution and Stability: 
  • Available as 1 mg/mL - 1 mL ampoule
  • Protect from light and heat. 
  • Store at room temperature. Do not freeze
  • Do not use if solution becomes discoloured

- Solutions Compatible: limited information on stability of dilutions in 0.9% NaCl; prepare immediately prior to use


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC YES - adult/adolescent
IM YES - adult/adolescent
IV Direct YES
Usual Dilution:  undiluted
Infusion Time: over 2 - 3 minutes
IV Intermittent Infusion YES
Usual Dilution: 25 - 50 mL 0.9% NaCl
Infusion Time:  30 - 60 minutes
IV Continuous Infusion NO



(For neonatal dosages, refer to Neonatal IV Drug Manual.)

- Use of  antiemetics (e.g. metoclopramide) 30 minutes prior to each dose is recommended due to the high incidence of nausea/vomiting

- Pediatric:

-  6 - 9 years - 0.1 mg/dose IV
-  10 - 12 years - 0.15 mg/dose IV
-  13 - 16 years - 0.2 mg/dose IV
- Repeat every 6 hours to a maximum of 16 doses; if no improvement after 5 doses, discontinue therapy

- Adult/Adolescent:

- 1 mg initially IV/IM/SC.  May repeat Q1H to a maximum of 3 mg/24 hours (SC or IM) or 2 mg/24 hours (IV)
- Total weekly dose should not exceed 6 mg by any route of injection


-  Dosing adjustment not required in mild to moderate renal impairment
-  Contraindicated in severe renal impairment


- Dosing adjustment suggested in mild to moderate hepatic impairment.  No guidelines available at this time
- Contraindicated in severe hepatic impairment


Potential hazards of parenteral administration: 
  • Central Nervous system:  dizziness, drowsiness, taste disorder, worsening of headache
  • Cardiovascular:  hypertension, myocardial ischemia, transient tachycardia or bradycardia
  • Gastrointestinal: diarrhea, nausea, vomiting, abdominal pain
  • Weakness in legs, muscle pain in extremities, numbness and tingling of fingers and toes
  • Hypersensitivity: rash, urticaria, edema, dyspnea
  • Onset of action occurs in 15 - 30 minutes following IM administration and within a few minutes after IV administration.
  • Duration of action in 3 - 4 hours following IM administration
  • Contraindicated in patients with ischemic or vasospastic heart disease, coronary artery disease, peripheral vascular disease, uncontrolled hypertension, severely impaired hepatic or renal function, pregnancy, sepsis, basilar or hemiplegic migraine
  • Avoid use within 24 hours of triptans (e.g. sumatriptan, zolmitriptan, rizatriptan) - risk of additive vasoconstriction/coronary vasopasm
  • Avoid use with potent cytochrome 3A4 inhibitors (e.g. protease inhibitors), macrolide antibiotics, and antifungal agents - risk of cerebral and/or peripheral ischemic


  • For first 2 doses:  baseline BP, then every 10 minutes x 3, and until stable
    Notify physician if BP is increased or decreased more than 15 mmHg diastolic or 30 mmHg systolinc in adults or 20% from baseline in children
    If chest pain develops on intermittent infusion, stop infusion and notify physician

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