Contraindication of Dihydroergotamine After Sumatriptan

Introduction to Contraindications

• A mandatory 24-hour washout period must elapse between the last dose of sumatriptan and administration of dihydroergotamine (DHE), as recommended by the American Academy of Family Physicians 1
• The American Academy of Family Physicians suggests that parenteral NSAIDs (ketorolac), prochlorperazine for both pain relief and nausea, metoclopramide as adjunctive therapy, and systemic steroids for status migrainosus can be considered as alternative non-vasoconstrictive rescue medications if DHE is contraindicated 2

Patient Screening

• Before administering DHE after the 24-hour window, ensure the patient does not have severely impaired hepatic or renal function, as advised by the American Academy of Family Physicians 1
• The American Academy of Family Physicians recommends that DHE should not be administered to patients who are pregnant or breastfeeding 1