Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who uses Migranal (Dihydroergotamine-nasal). If you are concerned about side effects, discuss the risks and benefits of Migranal (Dihydroergotamine-nasal) with your doctor.

The following side effects have been reported by at least 1% of people using Migranal (Dihydroergotamine-nasal). Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Stop using the medication and seek immediate medical attention if any of the following occur:

• chest pain
• cough, fever, sneezing, or sore throat
• feeling of heaviness in chest
• irregular heartbeat
• itching of the skin
• numbness and tingling of face, fingers, or toes
• pain in arms, legs, or lower back
• pain in back, chest, or left arm
• pale bluish-coloured or cold hands or feet
• shortness of breath or troubled breathing
• weak or absent pulses in legs

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are using Migranal (Dihydroergotamine-nasal).

Each mL of clear, colourless to faintly yellow solution contains dihydroergotamine mesylate USP 4 mg. Nonmedicinal ingredients: caffeine, dextrose, and water.

Do not use dihydroergotamine if you:

• are allergic to any of the ingredients
• are pregnant
• are a breast-feeding mother
• are taking the following medications
  • protease inhibitors (e.g., ritonavir, nelfinavir, indinavir)
  • macrolide antibiotics (e.g., erythromycin, clarithromycin, troleandomycin)
  • antifungal agents (e.g., ketoconazole, itraconazole)
• have Coronary Artery Disease
• have diseases of blood circulation
• have uncontrolled high blood pressure
• have severely impaired liver function
• have severely impaired kidney function

There may be other conditions where the doctor may not want you to use Migranal (Dihydroergotamine-nasal). Be sure to tell all health care professionals involved in your care about all your medical conditions.

There may be an interaction between dihydroergotamine and any of the following:

• antifungal agents (e.g., ketoconazole, itraconazole)
• cocaine
• Epinephrine by injection
• macrolide antibiotics (e.g., erythromycin, clarithromycin, troleandomycin)
• Naratriptan
• Nicotine
• other ergot medications (e.g., methysergide, ergonovine, ergoloid mesylates)
• protease inhibitors (e.g., ritonavir, nelfinavir, indinavir)
• Rizatriptan
• Sumatriptan

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Migranal (Dihydroergotamine-nasal). Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Migranal (Dihydroergotamine-nasal).

Dependence: If you take dihydroergotamine for extended periods of time you may become dependent upon it and require progressively increasing doses for relief of headaches or to prevent the increasing unpleasant effects which may follow withdrawal of the medication.

Drowsiness/reduced alertness: You should not undertake activities requiring mental alertness, such as operating equipment or driving a vehicle, until you determine your response and sensitivity to Migranal (Dihydroergotamine-nasal).

Overdose: It is important to stay within the limits of the recommended dosage of Migranal (Dihydroergotamine-nasal) and avoid excessive or prolonged use. An overdose of ergotamine is dangerous, and may cause the following effects:

• cold and pale skin
• confusion
• depression
• diarrhea
• dizziness
• drowsiness
• headache
• itching
• muscle pain
• nausea
• pain like that of Angina
• rapid and weak pulse
• rise and/or fall of blood pressure (usually in that order)
• slow or fast heart rate
• thirst
• tingling and numbness of the extremities
• unconsciousness
• vomiting

If an overdose is suspected, seek medical help immediately.

Pregnancy: Dihydroergotamine may cause harm when taken during pregnancy. If you become pregnant while using Migranal (Dihydroergotamine-nasal), contact your doctor immediately.

Breast-feeding: Dihydroergotamine passes into breast milk and may cause symptoms of vomiting, diarrhea, weak pulse, and unstable blood pressure in nursing infants. If you are a breast-feeding mother you should not take Migranal (Dihydroergotamine-nasal).

Children: The safety and effectiveness of Migranal (Dihydroergotamine-nasal) for children less than 16 years of age have not been established. It is not recommended for use by children.