U.S. Department of Health & Human Services Divider Arrow National Institutes of Health Divider Arrow NCATS

Details

Stereochemistry ABSOLUTE
Molecular Formula C33H37N5O5.CH4O3S
Molecular Weight 679.783
Optical Activity UNSPECIFIED
Defined Stereocenters 7 / 7
E/Z Centers 0
Charge 0

SHOW SMILES / InChI
Structure of DIHYDROERGOTAMINE MESYLATE

SMILES

CS(O)(=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=C7C(=CC=C8)[C@@]6([H])C5)O[C@@]24O

InChI

InChIKey=ADYPXRFPBQGGAH-UMYZUSPBSA-N
InChI=1S/C33H37N5O5.CH4O3S/c1-32(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;1-5(2,3)4/h3-6,8-11,17,21,23,25-27,34,42H,7,12-16,18H2,1-2H3,(H,35,39);1H3,(H,2,3,4)/t21-,23-,25-,26+,27+,32-,33+;/m1./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 CH4O3S
Molecular Weight 96.106
Charge 0
Count
Stereochemistry ACHIRAL
Additional Stereochemistry No
Defined Stereocenters 0 / 0
E/Z Centers 0
Optical Activity NONE

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

1946
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
Transient global amnesia, migraine, thalamic infarct, dihydroergotamine, and sumatriptan.
2000 Apr
Clinical ergotism induced by ritonavir.
2001
Hydergine for dementia.
2001
[Migraine: use of preventive agents].
2001 Apr 10
Current concepts of pelvic congestion and chronic pelvic pain.
2001 Apr-Jun
Complex interaction of ergovaline with 5-HT2A, 5-HT1B/1D, and alpha1 receptors in isolated arteries of rat and guinea pig.
2001 Aug
Ergot alkaloid transport across ruminant gastric tissues.
2001 Feb
A fresh look at migraine therapy. New treatments promise improved management.
2001 Jan
Successful withdrawal from analgesic abuse in a group of youngsters with chronic daily headache.
2001 Jun
Treatment of childhood headaches.
2001 Mar
Sumatriptin vs dihydroergotamine: patient preference.
2001 Mar
Ergotamine-induced acute vascular insufficiency of the lower limb--a case report.
2001 Mar
Application of oxygen vectors to Claviceps purpurea cultivation.
2001 May
An in vivo rat model to study calcitonin gene related peptide release following activation of the trigeminal vascular system.
2001 May
Neurogenic inflammation in the context of migraine.
2001 May 1
An unusual case of clarithromycin associated ergotism.
2001 Nov
Saint-Anthony's fire.
2001 Nov 17
Comparison of intravenous valproate versus intramuscular dihydroergotamine and metoclopramide for acute treatment of migraine headache.
2001 Nov-Dec
A simple thin-layer chromatographic method for the detection of ergovaline in leaf sheaths of tall fescue (Festuca arundinacea) infected with Neotyphodium coenophialum.
2001 Sep
Haemodynamic effects of three doses of dihydroergotamine during spinal anaesthesia.
2001 Sep
[Acute renal failure caused by dihydroergotamine].
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
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
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
Ergotamine-induced anorectal strictures: report of five cases.
2002 Feb
Naratriptan in the prophylaxis of cluster headache.
2002 Jan
The effect of rizatriptan, ergotamine, and their combination on human peripheral arteries: a double-blind, placebo-controlled, crossover study in normal subjects.
2002 Jul
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
[Use and misuse of triptans: a case report].
2002 Mar-Apr
Buccal absorption of ergotamine tartrate using the bioadhesive tablet system in guinea-pigs.
2002 May 15
[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
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 15:01:05 GMT 2023
Edited
by admin
on Fri Dec 15 15:01:05 GMT 2023
Record UNII
81AXN7R2QT
Record Status Validated (UNII)
Record Version
  • Download
Name Type Language
DIHYDROERGOTAMINE MESYLATE
ORANGE BOOK   USAN   USP   USP-RS   VANDF  
USAN  
Official Name English
ERGOTOMAN-3',6',18-TRIONE,9,10-DIHYDRO-12'-HYDROXY-2'-METHYL-5'-(PHENYLMETHYL)-, (5'.ALPHA.)-, MONOMETHANESULPHONATE (SALT)
Common Name English
Dihydroergotamine monomethanesulfonate
Common Name English
DIHYDROERGOTAMINE METHANESULFONATE [MI]
Common Name English
D.H.E. 45
Brand Name English
DIHYDROERGOTAMINE MESYLATE [ORANGE BOOK]
Common Name English
DIHYDROERGOTAMINE MESYLATE COMPONENT OF EMBOLEX
Common Name English
DIHYDROERGOTAMINE MESILATE
EP   MART.   WHO-DD  
Common Name English
Dihydroergotamine mesilate [WHO-DD]
Common Name English
DIHYDROERGOTAMINE MESYLATE [USAN]
Common Name English
DIHYDROERGOTAMINE MESILATE [EP IMPURITY]
Common Name English
EMBOLEX COMPONENT DIHYDROERGOTAMINE MESYLATE
Common Name English
DIHYDROERGOTAMINE MESYLATE [VANDF]
Common Name English
DHE-45
Code English
ERGOTOMAN-3',6',18-TRIONE,9,10-DIHYDRO-12'-HYDROXY-2'-METHYL-5'-(PHENYLMETHYL)-, (5'.ALPHA.)-, MONOMETHANESULFONATE (SALT)
Common Name English
DIHYDROERGOTAMINE METHANE SULFONATE
Common Name English
DIHYDROERGOTAMINE METHANESULFONATE
MI  
Common Name English
DIHYDROERGOTAMINE MESYLATE [USP-RS]
Common Name English
DIHYDROERGOTAMINE MESILATE [MART.]
Common Name English
MIGRANAL
Brand Name English
DIHYDROERGOTAMINE MESILATE [EP MONOGRAPH]
Common Name English
DIHYDROERGOTAMINE MESYLATE [USP MONOGRAPH]
Common Name English
DIHYDROERGOTAMINE MESILATE [JAN]
Common Name English
NSC-759848
Code English
DIHYDROERGOTAMINE MONOMETHANESULPHONATE
Common Name English
Classification Tree Code System Code
NCI_THESAURUS C2198
Created by admin on Fri Dec 15 15:01:06 GMT 2023 , Edited by admin on Fri Dec 15 15:01:06 GMT 2023
NCI_THESAURUS C66884
Created by admin on Fri Dec 15 15:01:06 GMT 2023 , Edited by admin on Fri Dec 15 15:01:06 GMT 2023
Code System Code Type Description
CHEBI
59756
Created by admin on Fri Dec 15 15:01:06 GMT 2023 , Edited by admin on Fri Dec 15 15:01:06 GMT 2023
PRIMARY
EVMPD
SUB01718MIG
Created by admin on Fri Dec 15 15:01:06 GMT 2023 , Edited by admin on Fri Dec 15 15:01:06 GMT 2023
PRIMARY
EPA CompTox
DTXSID00904615
Created by admin on Fri Dec 15 15:01:06 GMT 2023 , Edited by admin on Fri Dec 15 15:01:06 GMT 2023
PRIMARY
EVMPD
SUB30067
Created by admin on Fri Dec 15 15:01:06 GMT 2023 , Edited by admin on Fri Dec 15 15:01:06 GMT 2023
PRIMARY
NSC
759848
Created by admin on Fri Dec 15 15:01:06 GMT 2023 , Edited by admin on Fri Dec 15 15:01:06 GMT 2023
PRIMARY
DRUG BANK
DB00320
Created by admin on Fri Dec 15 15:01:06 GMT 2023 , Edited by admin on Fri Dec 15 15:01:06 GMT 2023
PRIMARY
RXCUI
203176
Created by admin on Fri Dec 15 15:01:06 GMT 2023 , Edited by admin on Fri Dec 15 15:01:06 GMT 2023
PRIMARY RxNorm
MERCK INDEX
m4461
Created by admin on Fri Dec 15 15:01:06 GMT 2023 , Edited by admin on Fri Dec 15 15:01:06 GMT 2023
PRIMARY Merck Index
NCI_THESAURUS
C47491
Created by admin on Fri Dec 15 15:01:06 GMT 2023 , Edited by admin on Fri Dec 15 15:01:06 GMT 2023
PRIMARY
RS_ITEM_NUM
1202005
Created by admin on Fri Dec 15 15:01:06 GMT 2023 , Edited by admin on Fri Dec 15 15:01:06 GMT 2023
PRIMARY
ECHA (EC/EINECS)
228-235-6
Created by admin on Fri Dec 15 15:01:06 GMT 2023 , Edited by admin on Fri Dec 15 15:01:06 GMT 2023
PRIMARY
ChEMBL
CHEMBL1732
Created by admin on Fri Dec 15 15:01:06 GMT 2023 , Edited by admin on Fri Dec 15 15:01:06 GMT 2023
PRIMARY
CAS
6190-39-2
Created by admin on Fri Dec 15 15:01:06 GMT 2023 , Edited by admin on Fri Dec 15 15:01:06 GMT 2023
PRIMARY
FDA UNII
81AXN7R2QT
Created by admin on Fri Dec 15 15:01:06 GMT 2023 , Edited by admin on Fri Dec 15 15:01:06 GMT 2023
PRIMARY
DAILYMED
81AXN7R2QT
Created by admin on Fri Dec 15 15:01:06 GMT 2023 , Edited by admin on Fri Dec 15 15:01:06 GMT 2023
PRIMARY
PUBCHEM
71171
Created by admin on Fri Dec 15 15:01:06 GMT 2023 , Edited by admin on Fri Dec 15 15:01:06 GMT 2023
PRIMARY
SMS_ID
100000090575
Created by admin on Fri Dec 15 15:01:06 GMT 2023 , Edited by admin on Fri Dec 15 15:01:06 GMT 2023
PRIMARY
Related Record Type Details
PARENT -> SALT/SOLVATE
Related Record Type Details
ACTIVE MOIETY