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Dihydroergotamine (DHE) – Then and Now: A Narrative Review
Author(s) -
Silberstein Stephen D.,
Shrewsbury Stephen B.,
Hoekman John
Publication year - 2020
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.13700
Subject(s) - dihydroergotamine , medicine , narrative review , migraine , medline , intensive care medicine , clinical trial , anesthesia , political science , law
Objective To provide a narrative review of clinical development programs for non‐oral, non‐injectable formulations of dihydroergotamine (DHE) for the treatment of migraine. Background Dihydroergotamine was one of the first “synthetic drugs” developed in the 20th century for treating migraine. It is effective and recommended for acute migraine treatment. Since oral DHE is extensively metabolized, it must be given by a non‐oral route. Intravenous DHE requires healthcare personnel to administer, subcutaneous/intramuscular injection is challenging to self‐administer, and the approved nasal spray formulation exhibits low bioavailability and high variability that limits its efficacy. Currently there are several attempts underway to develop non‐oral, non‐injected formulations of DHE. Method A systematic search of MEDLINE/PubMed and ClinicalTrials.gov databases, then narrative review of identified reports, focusing on those published in the last 10 years. Results Of 1881 references to DHE from a MEDLINE/PubMed search, 164 were from the last 10 years and were the focus of this review. Further cross reference was made to ClinicalTrials.gov for 19 clinical studies, of which some results have not yet been published, or are studies that are currently underway. Three nasal DHE products are in clinical development, reawakening interest in this route of delivery for migraine. Other routes of DHE administration have been, or are being, explored. Conclusion There is renewed appreciation for DHE and the need for non‐oral, non‐injected delivery is now being addressed.