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Details

Stereochemistry ABSOLUTE
Molecular Formula 4C33H37N5O5.C4H6O6
Molecular Weight 2484.7964
Optical Activity UNSPECIFIED
Defined Stereocenters 30 / 30
E/Z Centers 0
Charge 0

SHOW SMILES / InChI
Structure of DIHYDROERGOTAMINE TARTRATE

SMILES

O[C@H]([C@@H](O)C(O)=O)C(O)=O.[H][C@@]12CCCN1C(=O)[C@H](CC3=CC=CC=C3)N4C(=O)[C@](C)(NC(=O)[C@H]5CN(C)[C@]6([H])CC7=CNC8=CC=CC(=C78)[C@@]6([H])C5)O[C@@]24O.[H][C@@]9%10CCCN9C(=O)[C@H](CC%11=CC=CC=C%11)N%12C(=O)[C@](C)(NC(=O)[C@H]%13CN(C)[C@]%14([H])CC%15=CNC%16=CC=CC(=C%15%16)[C@@]%14([H])C%13)O[C@@]%10%12O.[H][C@@]%17%18CCCN%17C(=O)[C@H](CC%19=CC=CC=C%19)N%20C(=O)[C@](C)(NC(=O)[C@H]%21CN(C)[C@]%22([H])CC%23=CNC%24=CC=CC(=C%23%24)[C@@]%22([H])C%21)O[C@@]%18%20O.[H][C@@]%25%26CCCN%25C(=O)[C@H](CC%27=CC=CC=C%27)N%28C(=O)[C@](C)(NC(=O)[C@H]%29CN(C)[C@]%30([H])CC%31=CNC%32=CC=CC(=C%31%32)[C@@]%30([H])C%29)O[C@@]%26%28O

InChI

InChIKey=FXDJFTCVYTUARH-YZPGULDNSA-N
InChI=1S/4C33H37N5O5.C4H6O6/c4*1-32(35-29(39)21-15-23-22-10-6-11-24-28(22)20(17-34-24)16-25(23)36(2)18-21)31(41)38-26(14-19-8-4-3-5-9-19)30(40)37-13-7-12-27(37)33(38,42)43-32;5-1(3(7)8)2(6)4(9)10/h4*3-6,8-11,17,21,23,25-27,34,42H,7,12-16,18H2,1-2H3,(H,35,39);1-2,5-6H,(H,7,8)(H,9,10)/t4*21-,23-,25-,26+,27+,32-,33+;1-,2-/m11111/s1

HIDE SMILES / InChI

Molecular Formula C33H37N5O5
Molecular Weight 583.6774
Charge 0
Count
Stereochemistry ABSOLUTE
Additional Stereochemistry No
Defined Stereocenters 7 / 7
E/Z Centers 0
Optical Activity UNSPECIFIED

Molecular Formula C4H6O6
Molecular Weight 150.0868
Charge 0
Count
Stereochemistry ABSOLUTE
Additional Stereochemistry No
Defined Stereocenters 2 / 2
E/Z Centers 0
Optical Activity UNSPECIFIED

Dihydroergotamine (DHE) is a semisynthetic, hydrogenated ergot alkaloid, synthesized by reducing an unsaturated bond in ergotamine. Dihydroergotamine was originally envisaged as an antihypertensive agent, but it was later shown to be highly effective in treating migraine. Dihydroergotamine was first used to treat migraine in 1945 by Horton, Peters, and Blumenthal at the Mayo Clinic. In 1986, Raskin and Callaham reconfirmed the effectiveness of DHE for both intermittent and intractable migraine. The use of DHE was reviewed by Scott in 1992. In 1997, a nasal spray version was approved for use in migraine. Dihydroergotamine is indicated for the acute treatment of migraine headaches with or without aura and the acute treatment of cluster headache episodes. Dihydroergotamine binds with high affinity to 5-HT1Dα and 5-HT1Dβ receptors. It also binds with high affinity to serotonin 5-HT1A, 5-HT2A, and 5-HT2C receptors, noradrenaline α2A, α2B and α, receptors, and dopamine D2L and D3 receptors. The therapeutic activity of dihydroergotamine in migraine is generally attributed to the agonist effect at 5-HT1D receptors. Two current theories have been proposed to explain the efficacy of 5-HT1D receptor agonists in migraine. One theory suggests that activation of 5-HT1D receptors located on intracranial blood vessels, including those on arterio-venous anastomoses, leads to vasoconstriction, which correlates with the relief of migraine headache. The alternative hypothesis suggests that activation of 5-HT1D receptors on sensory nerve endings of the trigeminal system results in the inhibition of proinflammatory neuropeptide release.

Originator

Curator's Comment: Dihydroergotamine was synthesized (using hydrogenation [reduction] of the double bond at the 9- 10 position of the ergoline ring of E) by Stoll and Hofmann in 1943.

Approval Year

TargetsConditions

Conditions

ConditionModalityTargetsHighest PhaseProduct
Primary
D.H.E. 45

Approved Use

Dihydroergotamine Mesylate Injection, USP is indicated for the acute treatment of migraine headaches with or without aura and the acute treatment of cluster headache episodes.

Launch Date

-7.48656E11
Cmax

Cmax

ValueDoseCo-administeredAnalytePopulation
1.02 ng/mL
1 mg single, nasal
dose: 1 mg
route of administration: Nasal
experiment type: SINGLE
co-administered:
DIHYDROERGOTAMINE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: FEMALE / MALE
food status: UNKNOWN
AUC

AUC

ValueDoseCo-administeredAnalytePopulation
5.05 ng × h/mL
1 mg single, nasal
dose: 1 mg
route of administration: Nasal
experiment type: SINGLE
co-administered:
DIHYDROERGOTAMINE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: FEMALE / MALE
food status: UNKNOWN
T1/2

T1/2

ValueDoseCo-administeredAnalytePopulation
7.952 h
1 mg single, nasal
dose: 1 mg
route of administration: Nasal
experiment type: SINGLE
co-administered:
DIHYDROERGOTAMINE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: FEMALE / MALE
food status: UNKNOWN
Funbound

Funbound

ValueDoseCo-administeredAnalytePopulation
7%
1 mg single, nasal
dose: 1 mg
route of administration: Nasal
experiment type: SINGLE
co-administered:
DIHYDROERGOTAMINE plasma
Homo sapiens
population: HEALTHY
age: ADULT
sex: FEMALE / MALE
food status: UNKNOWN
Doses

Doses

DosePopulationAdverse events​
2 mg single, intranasal
Studied dose
Dose: 2 mg
Route: intranasal
Route: single
Dose: 2 mg
Sources:
unhealthy, 18 - 65 years
n = 1796
Health Status: unhealthy
Condition: migraine
Age Group: 18 - 65 years
Sex: M+F
Population Size: 1796
Sources:
Disc. AE: Rhinitis, Dizziness...
AEs leading to
discontinuation/dose reduction:
Rhinitis (2 patients)
Dizziness (2 patients)
Edema face (1 patient)
Cold sweat (1 patient)
Trauma (1 patient)
Depression (1 patient)
Somnolence (1 patient)
Allergy (1 patient)
Vomiting (1 patient)
Hypotension (1 patient)
Paraesthesia (1 patient)
Sources:
4 mg 1 times / day steady, intranasal
Highest studied dose
Dose: 4 mg, 1 times / day
Route: intranasal
Route: steady
Dose: 4 mg, 1 times / day
Sources:
unhealthy, adult
Health Status: unhealthy
Condition: migraine
Age Group: adult
Sex: unknown
Sources:
1 mg single, subcutaneous
Recommended
Dose: 1 mg
Route: subcutaneous
Route: single
Dose: 1 mg
Sources:
unhealthy, adult
Health Status: unhealthy
Condition: migraine
Age Group: adult
Sex: unknown
Sources:
Disc. AE: Cerebrovascular event...
AEs leading to
discontinuation/dose reduction:
Cerebrovascular event (grade 5)
Sources:
1 mg 1 times / day steady, subcutaneous (max)
Recommended
Dose: 1 mg, 1 times / day
Route: subcutaneous
Route: steady
Dose: 1 mg, 1 times / day
Sources:
unhealthy, adult
n = 51
Health Status: unhealthy
Condition: migraine
Age Group: adult
Sex: unknown
Population Size: 51
Sources:
Disc. AE: Nausea, Vomiting...
AEs leading to
discontinuation/dose reduction:
Nausea (20 patients)
Vomiting (3 patients)
Sources:
AEs

AEs

AESignificanceDosePopulation
Allergy 1 patient
Disc. AE
2 mg single, intranasal
Studied dose
Dose: 2 mg
Route: intranasal
Route: single
Dose: 2 mg
Sources:
unhealthy, 18 - 65 years
n = 1796
Health Status: unhealthy
Condition: migraine
Age Group: 18 - 65 years
Sex: M+F
Population Size: 1796
Sources:
Cold sweat 1 patient
Disc. AE
2 mg single, intranasal
Studied dose
Dose: 2 mg
Route: intranasal
Route: single
Dose: 2 mg
Sources:
unhealthy, 18 - 65 years
n = 1796
Health Status: unhealthy
Condition: migraine
Age Group: 18 - 65 years
Sex: M+F
Population Size: 1796
Sources:
Depression 1 patient
Disc. AE
2 mg single, intranasal
Studied dose
Dose: 2 mg
Route: intranasal
Route: single
Dose: 2 mg
Sources:
unhealthy, 18 - 65 years
n = 1796
Health Status: unhealthy
Condition: migraine
Age Group: 18 - 65 years
Sex: M+F
Population Size: 1796
Sources:
Edema face 1 patient
Disc. AE
2 mg single, intranasal
Studied dose
Dose: 2 mg
Route: intranasal
Route: single
Dose: 2 mg
Sources:
unhealthy, 18 - 65 years
n = 1796
Health Status: unhealthy
Condition: migraine
Age Group: 18 - 65 years
Sex: M+F
Population Size: 1796
Sources:
Hypotension 1 patient
Disc. AE
2 mg single, intranasal
Studied dose
Dose: 2 mg
Route: intranasal
Route: single
Dose: 2 mg
Sources:
unhealthy, 18 - 65 years
n = 1796
Health Status: unhealthy
Condition: migraine
Age Group: 18 - 65 years
Sex: M+F
Population Size: 1796
Sources:
Paraesthesia 1 patient
Disc. AE
2 mg single, intranasal
Studied dose
Dose: 2 mg
Route: intranasal
Route: single
Dose: 2 mg
Sources:
unhealthy, 18 - 65 years
n = 1796
Health Status: unhealthy
Condition: migraine
Age Group: 18 - 65 years
Sex: M+F
Population Size: 1796
Sources:
Somnolence 1 patient
Disc. AE
2 mg single, intranasal
Studied dose
Dose: 2 mg
Route: intranasal
Route: single
Dose: 2 mg
Sources:
unhealthy, 18 - 65 years
n = 1796
Health Status: unhealthy
Condition: migraine
Age Group: 18 - 65 years
Sex: M+F
Population Size: 1796
Sources:
Trauma 1 patient
Disc. AE
2 mg single, intranasal
Studied dose
Dose: 2 mg
Route: intranasal
Route: single
Dose: 2 mg
Sources:
unhealthy, 18 - 65 years
n = 1796
Health Status: unhealthy
Condition: migraine
Age Group: 18 - 65 years
Sex: M+F
Population Size: 1796
Sources:
Vomiting 1 patient
Disc. AE
2 mg single, intranasal
Studied dose
Dose: 2 mg
Route: intranasal
Route: single
Dose: 2 mg
Sources:
unhealthy, 18 - 65 years
n = 1796
Health Status: unhealthy
Condition: migraine
Age Group: 18 - 65 years
Sex: M+F
Population Size: 1796
Sources:
Dizziness 2 patients
Disc. AE
2 mg single, intranasal
Studied dose
Dose: 2 mg
Route: intranasal
Route: single
Dose: 2 mg
Sources:
unhealthy, 18 - 65 years
n = 1796
Health Status: unhealthy
Condition: migraine
Age Group: 18 - 65 years
Sex: M+F
Population Size: 1796
Sources:
Rhinitis 2 patients
Disc. AE
2 mg single, intranasal
Studied dose
Dose: 2 mg
Route: intranasal
Route: single
Dose: 2 mg
Sources:
unhealthy, 18 - 65 years
n = 1796
Health Status: unhealthy
Condition: migraine
Age Group: 18 - 65 years
Sex: M+F
Population Size: 1796
Sources:
Cerebrovascular event grade 5
Disc. AE
1 mg single, subcutaneous
Recommended
Dose: 1 mg
Route: subcutaneous
Route: single
Dose: 1 mg
Sources:
unhealthy, adult
Health Status: unhealthy
Condition: migraine
Age Group: adult
Sex: unknown
Sources:
Nausea 20 patients
Disc. AE
1 mg 1 times / day steady, subcutaneous (max)
Recommended
Dose: 1 mg, 1 times / day
Route: subcutaneous
Route: steady
Dose: 1 mg, 1 times / day
Sources:
unhealthy, adult
n = 51
Health Status: unhealthy
Condition: migraine
Age Group: adult
Sex: unknown
Population Size: 51
Sources:
Vomiting 3 patients
Disc. AE
1 mg 1 times / day steady, subcutaneous (max)
Recommended
Dose: 1 mg, 1 times / day
Route: subcutaneous
Route: steady
Dose: 1 mg, 1 times / day
Sources:
unhealthy, adult
n = 51
Health Status: unhealthy
Condition: migraine
Age Group: adult
Sex: unknown
Population Size: 51
Sources:
Overview

Overview

CYP3A4CYP2C9CYP2D6hERG

OverviewOther

Other InhibitorOther SubstrateOther Inducer




Drug as perpetrator​

Drug as perpetrator​

Drug as victim

Drug as victim

TargetModalityActivityMetaboliteClinical evidence
yes
PubMed

PubMed

TitleDatePubMed
Ergotamine, dihydroergotamine: current uses and problems.
2001
Management of hot flashes in breast-cancer survivors.
2001 Apr
[Ormond's fibrosis, bone osteolysis and stomach intramural metastases in the course f low-differentiated prostatic cancer].
2001 Jul
Treatment of childhood headaches.
2001 Mar
Comparison of intravenous valproate versus intramuscular dihydroergotamine and metoclopramide for acute treatment of migraine headache.
2001 Nov-Dec
Migraines.
2001 Nov-Dec
[Headaches caused by abuse of symptomatic anti-migraine and analgesic treatment].
2001 Oct
[Migraine and facial pain].
2001 Oct 15
[The problems of migraine headache treatment].
2002
[Acute renal failure caused by dihydroergotamine].
2002
Practical approaches to migraine management.
2002
Efficacy, tolerability and safety of oral eletriptan and ergotamine plus caffeine (Cafergot) in the acute treatment of migraine: a multicentre, randomised, double-blind, placebo-controlled comparison.
2002
Frovatriptan: a review of drug-drug interactions.
2002 Apr
Specific labelling of serotonin 5-HT(1B) receptors in rat frontal cortex with the novel, phenylpiperazine derivative, [3H]GR125,743. A pharmacological characterization.
2002 Apr
Successful treatment of threatening limb loss ischemia of the upper limb caused by ergotamine. A case report and review of the literature.
2002 Apr
Therapeutic strategies for orthostatic intolerance: mechanisms, observations, and making patients feel better.
2002 Apr 1
Comparative effects of clonidine and dihydroergotamine on venomotor tone and orthostatic tolerance in patients with severe hypoadrenergic orthostatic hypotension.
2002 Apr 1
Valvular heart disease in patients taking pergolide.
2002 Dec
Fibrosis due to ergot derivatives: exposure to risk should be weighed up.
2002 Dec
The antimigraine 5-HT 1B/1D receptor agonists, sumatriptan, zolmitriptan and dihydroergotamine, attenuate pain-related behaviour in a rat model of trigeminal neuropathic pain.
2002 Dec
Management of the acute migraine headache.
2002 Dec 1
Ergotamine-induced anorectal strictures: report of five cases.
2002 Feb
Naratriptan in the prophylaxis of cluster headache.
2002 Jan
Syndrome of cerebrospinal fluid hypovolemia following lumbar puncture cerebrospinal fluid leak in a patient with idiopathic intracranial hypertension.
2002 Jan
[Migraine: a disease, not a symptom].
2002 Jan 1
[Treatment of migraine in patients with hypertension and ischemic heart disease].
2002 Jan 20
[Critical ischaemia of the limbs and localized livedo in a case of ergotism].
2002 Jan 25
The effect of rizatriptan, ergotamine, and their combination on human peripheral arteries: a double-blind, placebo-controlled, crossover study in normal subjects.
2002 Jul
Fatal ergotism induced by an HIV protease inhibitor.
2002 Jul-Aug
Endocardial myxomatous change in Harlan Sprague-Dawley rats (Hsd:S-D) and CD-1 mice: its microscopic resemblance to drug-induced valvulopathy in humans.
2002 Jul-Aug
Intravenous valproate sodium in the treatment of daily headache.
2002 Jun
Endocrine and respiratory responses to ergotamine in Brahman and Hereford steers.
2002 Jun
Cardiovascular, respiratory, and body temperature responses of sheep to the ergopeptides ergotamine and ergovaline.
2002 Mar
New treatments in cluster headache.
2002 Mar
Treatment patterns of isolated benign headache in US emergency departments.
2002 Mar
Sensitive and specific liquid chromatographic-tandem mass spectrometric assay for dihydroergotamine and its major metabolite in human plasma.
2002 Mar 5
[Use and misuse of triptans: a case report].
2002 Mar-Apr
Wilfred Harris' early description of cluster headache.
2002 May
Incidence and determinants of migraine prophylactic medication in the Netherlands.
2002 May
Buccal absorption of ergotamine tartrate using the bioadhesive tablet system in guinea-pigs.
2002 May 15
Fibrotic valvular heart disease subsequent to bromocriptine treatment.
2002 Nov-Dec
Efficacy and tolerability of prochlorperazine buccal tablets in treatment of acute migraine.
2002 Oct
The early use of ergotamine in migraine. Edward Woakes' report of 1868, its theoretical and practical background and its international reception.
2002 Oct
[Ergotism in a patient treated with ritonavir and ergotamine].
2002 Oct 26
Simplified extraction of ergovaline and peramine for analysis of tissue distribution in endophyte-infected grass tillers.
2002 Oct 9
Hemicrania continua: a report of ten new cases.
2002 Sep
Drug combinations in the therapy of low response to phosphodiesterase 5 inhibitors in patients with erectile dysfunction.
2002 Sep-Oct
Crossover comparison of efficacy and preference for rizatriptan 10 mg versus ergotamine/caffeine in migraine.
2003
Pharmacological characterization of 5-HT(1B) receptor-mediated inhibition of local excitatory synaptic transmission in the CA1 region of rat hippocampus.
2003 Jan
Variations among emergency departments in the treatment of benign headache.
2003 Jan
Patents

Sample Use Guides

Usual Adult Dose for Migraine IM or subcutaneous: Initial dose: 1 mg given as quickly as possible after the first symptom of headache. Additional 1 mg doses can be given hourly until the headache has stopped or a total dose of 3 mg has been reached. The total weekly dose should not exceed 6 mg. IV: Initial dose: 1 mg given as quickly as possible after the first symptom of headache. Additional 1 mg doses can be given hourly until the headache has stopped or a total dose of 2 mg has been reached. The total weekly dose should not exceed 6 mg. Intranasal: 1 spray (0.5 mg) into each nostril (total = 1 mg). Repeat if needed within 15 minutes to a maximum of 4 sprays (2 mg) per day. The total weekly dose should not exceed 8 sprays (4 mg). Usual Adult Dose for Cluster Headache IM or subcutaneous: Initial dose: 1 mg given as quickly as possible after the first symptom of headache. Additional 1 mg doses can be given hourly until the headache has stopped or a total dose of 3 mg has been reached. The total weekly dose should not exceed 6 mg. IV: Initial dose: 1 mg given as quickly as possible after the first symptom of headache. Additional 1 mg doses can be given hourly until the headache has stopped or a total dose of 2 mg has been reached. The total weekly dose should not exceed 6 mg.
Route of Administration: Other
Dihydroergotamine (DHE) (EC(50)=10.9+/-0.3 nM) and 8'-OH-DHE (EC(50)=30.4+/-0.8 nM) inhibited the firing of serotoninergic neurons in the rat dorsal raphe nucleus within brain stem slices.
Substance Class Chemical
Created
by admin
on Fri Dec 15 18:37:34 UTC 2023
Edited
by admin
on Fri Dec 15 18:37:34 UTC 2023
Record UNII
76F2R89O7X
Record Status Validated (UNII)
Record Version
  • Download
Name Type Language
DIHYDROERGOTAMINE TARTRATE
WHO-DD  
Common Name English
Dihydroergotamine tartrate [WHO-DD]
Common Name English
Code System Code Type Description
FDA UNII
76F2R89O7X
Created by admin on Fri Dec 15 18:37:34 UTC 2023 , Edited by admin on Fri Dec 15 18:37:34 UTC 2023
PRIMARY
CAS
5989-77-5
Created by admin on Fri Dec 15 18:37:34 UTC 2023 , Edited by admin on Fri Dec 15 18:37:34 UTC 2023
PRIMARY
RXCUI
236680
Created by admin on Fri Dec 15 18:37:34 UTC 2023 , Edited by admin on Fri Dec 15 18:37:34 UTC 2023
PRIMARY RxNorm
SMS_ID
100000087507
Created by admin on Fri Dec 15 18:37:34 UTC 2023 , Edited by admin on Fri Dec 15 18:37:34 UTC 2023
PRIMARY
EVMPD
SUB01719MIG
Created by admin on Fri Dec 15 18:37:34 UTC 2023 , Edited by admin on Fri Dec 15 18:37:34 UTC 2023
PRIMARY
EPA CompTox
DTXSID30859427
Created by admin on Fri Dec 15 18:37:34 UTC 2023 , Edited by admin on Fri Dec 15 18:37:34 UTC 2023
PRIMARY
DRUG BANK
DBSALT001066
Created by admin on Fri Dec 15 18:37:34 UTC 2023 , Edited by admin on Fri Dec 15 18:37:34 UTC 2023
PRIMARY
PUBCHEM
76963764
Created by admin on Fri Dec 15 18:37:34 UTC 2023 , Edited by admin on Fri Dec 15 18:37:34 UTC 2023
PRIMARY
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