Shafqat Rafia, Flores-Montanez Yadira, Delbono Victoria, Nahas Stephanie J
Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
J Pain Res. 2020 Apr 30;13:859-864. doi: 10.2147/JPR.S203650. eCollection 2020.
Dihydroergotamine (DHE) is an ergot alkaloid derivative of substances produced by rye fungus. Ergotamine was first used in the field of gynecology and obstetrics, then used for migraine treatment a few years later. DHE was developed as a derivative of ergotamine. DHE, when compared to ergotamine, demonstrates greater alpha-adrenergic antagonist activity, lower arterial vasoconstriction, less dopaminergic agonism, and lower emetic potential. DHE can be delivered via several routes including intravenous (IV), intramuscular (IM), subcutaneous (SC), intranasal (IN), oral, and orally inhaled (although the latter two are not available in the USA and the last remains experimental only). DHE can be used in an outpatient basis in infusion centers, emergency departments, and urgent care centers, as well as inpatient treatment for admitted patients. There are protocols for adults as well as pediatric migraine treatment. DHE and other ergot alkaloids are considered contraindicated in pregnant women as they decrease uterine blood flow and increase uterine muscle contractility predisposing to spontaneous abortion. DHE during lactation is also not recommended as it can lead to gastrointestinal distress and weakness in infants; it can also suppress milk production. Caution should be taken before administering DHE in patients with cardiovascular risk factors. DHE is an older drug with an interesting history, yet it is still clinically useful today for patients with migraine attacks not responsive to triptans, who have a greater burden from migraine, and in refractory migraine.
双氢麦角胺（DHE）是一种由黑麦真菌产生的物质的麦角生物碱衍生物。麦角胺最初用于妇产科领域，几年后用于偏头痛治疗。DHE是作为麦角胺的衍生物开发的。与麦角胺相比，DHE表现出更强的α-肾上腺素能拮抗剂活性、更低的动脉血管收缩作用、更少的多巴胺能激动作用和更低的致吐潜力。DHE可以通过多种途径给药，包括静脉内（IV）、肌内（IM）、皮下（SC）、鼻内（IN）、口服和口服吸入（尽管后两种在美国不可用，最后一种仅处于实验阶段）。DHE可用于输液中心、急诊科和紧急护理中心的门诊治疗，以及住院患者的住院治疗。有针对成人和儿童偏头痛治疗的方案。DHE和其他麦角生物碱被认为在孕妇中禁用，因为它们会减少子宫血流量并增加子宫肌肉收缩力，易导致自然流产。哺乳期也不建议使用DHE，因为它会导致婴儿胃肠道不适和虚弱；还会抑制乳汁分泌。对于有心血管危险因素的患者，在使用DHE之前应谨慎。DHE是一种历史悠久的药物，然而，对于对曲坦类药物无反应、偏头痛负担更大的偏头痛患者以及难治性偏头痛患者，它在当今临床上仍然有用。
