Last update: Aug. 7, 2019

Dihydroergotamine

Low Risk for breastfeeding


Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
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Ergot alkaloid and alpha adrenergic receptor antagonist with vasoconstrictor effect which is less effective than ergotamine.
Indicated in the treatment of acute migraine attack, usually together with caffeine. It is also used in orthostatic hypotension and prophylaxis of venous thromboembolism.
Subcutaneous, intramuscular, intranasal or oral administration every half hour if necessary, up to a maximum of 2-3 mg per day.

Since the last update we have not found published data on its excretion in breastmilk.

Its moderately high molecular weight and high plasma protein binding and large volume of distribution (AEMPS 2014, FDA 2008) make it unlikely it will transfer into breastmilk in significant amounts.

Its very low oral bioavailability (AEMPS 2014, FDA 2008) impedes its transfer from breastmilk to infant plasma, except in premature infants and the immediate neonatal period when there may be greater intestinal permeability.

Like other ergot alkaloids, it can inhibit prolactin secretion (Danjou 1989).

Occasional use and at a sufficient minimum dose would not create problems during breastfeeding.

Until there is more published data on this drug in relation to breastfeeding, safer known alternatives are preferable (Bordini 2016, Davanzo 2014, Duong 2010, Jürgens 2009, Loder 2007, MacGregor 2007, Moretti 2000), especially during the neonatal period and in cases of prematurity.

Sumatriptan, which is known to have minimal transfer to milk (Wojnar 1996), is a good alternative as a treatment for migraine during breastfeeding, and it is also more effective than the ergotamine/caffeine combination (Worthington 2013).


See below the information of this related product:

Alternatives

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

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Group

Dihydroergotamine belongs to this group or family:

Tradenames

Main tradenames from several countries containing Dihydroergotamine in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 6 - 8 %
Molecular weight 584 daltons
Protein Binding 90 - 95 %
VD 11 - 30 l/Kg
Tmax 0,25 - 2 hours
T1/2 9 - 32 hours

References

  1. Bordini CA, Roesler C, Carvalho Dde S, Macedo DD, Piovesan É, Melhado EM, Dach F, Kowacs F, Silva Júnior HM, Souza JA, Maciel JA Jr, Carvalho JJ, Speciali JG, Barea LM, Queiroz LP, Ciciarelli MC, Valença MM, Lima MM, Vincent MB. Recommendations for the treatment of migraine attacks - a Brazilian consensus. Arq Neuropsiquiatr. 2016 Abstract Full text (link to original source) Full text (in our servers)
  2. Davanzo R, Bua J, Paloni G, Facchina G. Breastfeeding and migraine drugs. Eur J Clin Pharmacol. 2014 Abstract
  3. AEMPS - Mizar. Dihidroergotamina (Tonopan). Ficha técnica. 2014 Full text (in our servers)
  4. Worthington I, Pringsheim T, Gawel MJ, Gladstone J, Cooper P, Dilli E, Aube M, Leroux E, Becker WJ; Canadian Headache Society Acute Migraine Treatment Guideline Development Group.. Canadian Headache Society Guideline: acute drug therapy for migraine headache. Can J Neurol Sci. 2013 Sep;40(5 Suppl 3):S1-S80. Review. Abstract
  5. Duong S, Bozzo P, Nordeng H, Einarson A. Safety of triptans for migraine headaches during pregnancy and breastfeeding. Can Fam Physician. 2010 Abstract Full text (link to original source) Full text (in our servers)
  6. Jürgens TP, Schaefer C, May A. Treatment of cluster headache in pregnancy and lactation. Cephalalgia. 2009 Abstract
  7. FDA-Draxis Dihydroergotamine (DHE 45). Drug Summary. 2008 Full text (in our servers)
  8. MacGregor EA. Migraine in pregnancy and lactation: a clinical review. J Fam Plann Reprod Health Care. 2007 Abstract Full text (in our servers)
  9. Loder E. Migraine in pregnancy. Semin Neurol. 2007 Abstract
  10. Moretti ME, Lee A, Ito S. Which drugs are contraindicated during breastfeeding? Practice guidelines. Can Fam Physician. 2000 Sep;46:1753-7. Review. Abstract Full text (link to original source) Full text (in our servers)
  11. Wojnar-Horton RE, Hackett LP, Yapp P, Dusci LJ, Paech M, Ilett KF. Distribution and excretion of sumatriptan in human milk. Br J Clin Pharmacol. 1996 Abstract Full text (link to original source) Full text (in our servers)
  12. Danjou P, Lacomblez L, Warot D, Puech AJ. Effects of dihydroergotamine on psychomotor function, neuroendocrine parameters and blood pressure, in healthy volunteers. Int Clin Psychopharmacol. 1989 Jan;4(1):71-83. Abstract

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