Dihydroergotamine (DHE) – Is there a place for its use?
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Medical University of Warsaw, Poland
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Kamilla Blecharz-Klin   

Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland
J Pre Clin Clin Res. 2018;12(4):149-157
Nowadays, dihydroergotamine (DHE) is sporadically used as a vasoconstrictor in the treatment of acute migraine. The importance of this drug in medicine has significantly decreased in the recent years. Limitations on the use of dihydroergotamine are due to the high toxicity and increased the risk of severe adverse events after prolonged theraphy. The Committee for Medicinal Products for Human Use of the European Medicines Agency recommends limiting the use of drugs that contain ergotamine derivatives due to the potential risk of ischemic vascular events, fibrosis and ergotism. However, ergot alcaloids preparations are not recommended for use in the prophylaxis of migraine pain, although it is still a good alternative for people with status migrainosus, migraine recurrence or chronic daily headache that do not respond to the classical theraphy. In clinical practice, DHE can be used as a rescue medication to treat migraine attacks involving aura or without aura, as well as for the acute treatment of cluster headache episodes. The effectiveness of DHE in alleviating migraine headache was assessed in multiple clinical studies. This review describes the pharmacodynamic and pharmacokinetic properties of DHE in an expanded view and its role in modern therapy based on available clinical trials. Most clinical data confirm that the drug is still an important element of contemporary migraine therapy, especially in cases when conventional medicine fails.

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