Proper Use of This Medicine

Use this medicine only as directed by your doctor. Do not use more of it, and do not use it more often, than directed . If the amount you are to use does not relieve your headache, check with your doctor. Taking too much dihydroergotamine or ergotamine, or taking it too often, may cause serious effects, especially in elderly patients. Also, if a headache medicine (especially ergotamine) is used too often for migraines, it may lose its effectiveness or even cause a type of physical dependence. If this occurs, your headaches may actually get worse.

This medicine works best if you:

• Use it at the first sign of headache or migraine attack. If you get warning signals of a coming migraine, take it before the headache actually starts .
• Lie down in a quiet, dark room until you are feeling better .

Your doctor may direct you to take another medicine to help prevent headaches. It is important that you follow your doctor's directions, even if your headaches continue to occur . Headache-preventing medicines may take several weeks to start working. Even after they do start working, your headaches may not go away completely. However, your headaches should occur less often, and they should be less severe and easier to relieve. This can reduce the amount of dihydroergotamine, ergotamine, or pain relievers that you need. If you do not notice any improvement after several weeks of headache-preventing treatment, check with your doctor.

For patients using dihydroergotamine :

• Dihydroergotamine is given only by injection. Your health care professional will teach you how to inject yourself with the medicine. Be sure to follow the directions carefully. Check with your health care professional if you have any problems using the medicine.

For patients using the sublingual (under-the-tongue) tablets of ergotamine :

• To use—Place the tablet under your tongue and let it remain there until it disappears. The sublingual tablet should not be chewed or swallowed, because it works faster when it is absorbed into the body through the lining of the mouth. Do not eat, drink, or smoke while the tablet is under your tongue.

For patients using rectal suppository forms of a headache medicine :

• If the suppository is too soft to use, chill it in the refrigerator for 30 minutes or run cold water over it before removing the foil wrapper.
• If you have been directed to use part of a suppository, you should divide the suppository into pieces that all contain the same amount of medicine. To do this, use a sharp knife and carefully cut the suppository lengthwise (from top to bottom) into pieces that are the same size. The suppository will be easier to cut if it has been kept in the refrigerator.
• To insert the suppository—First remove the foil wrapper and moisten the suppository with cold water. Lie down on your side and use your finger to push the suppository well up into the rectum.

Dosing—The dose of these headache medicines will be different for different patients. Follow your doctor's orders or the directions on the label . The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

For dihydroergotamine
• Adults: For relieving a migraine or cluster headache—1 mg. If your headache is not better, and no side effects are occurring, a second 1-mg dose may be used at least one hour later.
• Children 6 years of age and older: For relieving a migraine headache—It is not likely that a child will be receiving dihydroergotamine at home. If a child needs the medicine, the dose will have to be determined by the doctor.

For ergotamine
• Some headache medicines contain only ergotamine. Some of them contain other medicines along with the ergotamine. The number of tablets, capsules, or suppositories that you need for each dose depends on the amount of ergotamine in them. The size of each dose, and the number of doses that you take, also depends on the reason you are taking the medicine and on how you react to the medicine.
• For oral (capsule or tablet) and sublingual (under-the-tongue tablet) dosage forms:
  • Adults:
    • For relieving a migraine or cluster headache—1 or 2 mg of ergotamine. If your headache is not better, and no side effects are occurring, a second dose and even a third dose may be taken; however the doses should be taken at least 30 minutes apart. People who usually need more than one dose of the medicine, and who do not get side effects from it, may be able to take a larger first dose of not more than 3 mg of ergotamine. This may provide better relief of the headache with only one dose. The medicine should not be taken more often than 2 times a week, at least five days apart .
    • For preventing cluster headaches—The dose of ergotamine, and the number of doses you need every day, will depend on how many headaches you usually get each day. For some people, 1 or 2 mg of ergotamine once a day may be enough. Other people may need to take 1 or 2 mg of ergotamine 2 or 3 times a day.
    • For all uses— Do not take more than 6 mg of ergotamine a day in the form of capsules or tablets .
  • Children 6 years of age and older: For relieving migraine headaches—1 mg of ergotamine. If the headache is not better, and no side effects are occurring, a second dose and even a third dose may be taken; however, the doses should be taken at least 30 minutes apart. Children should not take more than 3 mg of ergotamine a day in the form of capsules or tablets. Also, this medicine should not be taken more often than 2 times a week, at least five days apart .
• For rectal suppository dosage forms:
  • Adults: For relieving migraine or cluster headaches—Usually 1 mg of ergotamine, but the dose may range from half of this amount to up to 2 mg. If your headache is not better, and no side effects are occurring, a second dose and even a third dose may be used; however the doses should be taken at least 30 minutes apart. People who usually need more than one dose of the medicine, and who do not get side effects from it, may be able to use a larger first dose of not more than 3 mg. This may provide better relief of the headache with only one dose. Adults should not use more than 4 mg of ergotamine a day in suppository form. Also, this medicine should not be used more often than 2 times a week, at least five days apart .
  • Children 6 years of age and older: For relieving migraine headaches—One-half or 1 mg of ergotamine. Children should not receive more than 1 mg a day of ergotamine in suppository form. Also, this medicine should not be used more often than 2 times a week, at least five days apart .

Storage—To store this medicine:

• Keep out of the reach of children since overdose is especially dangerous in children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Suppositories should be stored in a cool place, but not allowed to freeze. Some manufacturers recommend keeping them in a refrigerator; others do not. Follow the directions on the package. However, cutting the suppository into smaller pieces, if you need to do so, will be easier if the suppository is kept in the refrigerator.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.