When This Medicine Should Not Be Used:
This medicine is not right for everyone. Do not use it if you had an allergic reaction to dihydroergotamine or medicines that contain ergotamine or ergot. Do not use if you are pregnant or breastfeeding, or if you have heart or blood vessel disease, angina, or a recent heart attack.

How to Use This Medicine:
Spray

• Your doctor will prescribe your exact dose. Use this medicine as directed.
• This medicine is for use only in the nose. Do not get any of it in your eyes or on your skin. If it does get on these areas, rinse it off right away.
• Do not prepare the spray until you are ready to use it. After you prepare the spray, you must use the medicine within 8 hours.
• Prime the spray before you use it. To do this, pump the bottle 4 times until some of the medicine sprays out. Now it is ready to use.
• Each spray vial contains 1 complete dose of medicine and should be used for only 1 migraine attack. Throw away any leftover medicine.
• Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
• Missed dose: Dihydroergotamine is used only when you have a migraine. It is not used on a regular schedule.
• Store the medicine at room temperature, away from heat and direct light. Do not refrigerate or freeze.
• Throw away used needles in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Do not use clarithromycin, erythromycin, indinavir, itraconazole, ketoconazole, nelfinavir, ritonavir, or troleandomycin while you are using dihydroergotamine.
• Tell your doctor if you use other medicine to treat migraines, such as sumatriptan. You should not use sumatriptan or other ergot medicines within 24 hours of using dihydroergotamine.
• Some medicines can affect how dihydroergotamine works. Tell your doctor if you are using clotrimazole, fluconazole, fluoxetine, fluvoxamine, nefazodone, saquinavir, zileuton, or blood pressure medicine (such as propranolol).
• Do not eat grapefruit or drink grapefruit juice while you are using this medicine.

Warnings While Using This Medicine:

• It is not safe to take this medicine during pregnancy. It could harm an unborn baby. Tell your doctor right away if you become pregnant.
• Tell your doctor if you have kidney or liver disease, high blood pressure, high cholesterol, or diabetes. Tell your doctor if you have a history of stroke or a family history of heart disease. Tell your doctor if you smoke.
• This medicine may cause the following problems:
  
  • Risk of heart attack or heart rhythm problems (rare)
  • Increased blood pressure
  • Higher risk of stroke
• This medicine helps stop migraine headaches. It does not relieve pain or stop other kinds of headaches.
• This medicine may make you dizzy or drowsy. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Confusion, sudden or severe headache, trouble seeing, speaking, or walking
• Fast, pounding, or uneven heartbeat, chest pain, wheezing or trouble breathing
• Lightheadedness, dizziness, fainting
• Muscle pain or weakness
• Numbness, tingling, or cold feeling in your hands or feet

If you notice these less serious side effects, talk with your doctor:

• Change in taste, mild nausea
• Dryness, irritation, pain, or bleeding in your nose
• Runny or stuffy nose

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088