New dihydroergatamine injector
New dihydroergatamine injector
Brekiya (dihydroergotamine mesylate) Subcutaneous Injection as acute therapy for migraine with and without aura and Cluster headaches.
This drug came in May of 2025 and it delivers a 1 mg dose subcutaneously by an autoinjector in the mid thigh.
This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, Migraine textbook author, Podcaster, YouTube video producer, and Blogger.
Administration: Brekiya is given subcutaneously by the patient at onset of a migraine or cluster headache. It is the first dihydroergotamine autoinjector approved for acute migraine and cluster headaches. It is the same type of medication commonly used in hospital. It delivers a convenient at-home treatment option.
There is no need for refrigeration, assembly, or priming. It may be helpful for patients with nonresponse issues with triptans or other oral migraine therapy.
The device delivers a 1 mg dose subcutaneously, eliminating the need for refrigeration, assembly, or priming, and is suitable for patients with oral therapy issues.
DHE history and use: Dyhydroergotamine was synthesized by Stoll and Hoffman in 1943 and was used to treat migraine by Horton, Peters, and Blumenthal at the Mayo Clinic. Currently it is commonly used for inpatient treatment at headache centers or individually by neurologists. Dihydroergotamine in hospital is given intravenously, but it us used by outpatients as nasal spray Migranal. Dihydroergotamine is an ergot alkaloid. It activates vascular serotonin 5-HTD1 receptors, constricting cranial and peripheral blood vessels.
Indication: acute migraine or cluster headache. Brekiaya is a ready-to-use, subcutaneous autoinjector form that can be self-adminstered. A1 mg dose is delivered into the thigh which does not require refrigeration, assembly, or priming.
Up to 2 additional doses of the original 1 mg single dose may be administered, with at least 1 hour between each dose. Total use should not exceed 3 doses in 24 hours or 6 doses in 1 week.
Side effects: common- paresthesia, dizziness, flushing, anxiety, diarrhea, sweating; severe-stroke, cerebral hemorrhage, subarachnoid hemorrhage, cerebral ischemia, intestinal or peripheral ischemia.
Black Box warning: Serious and/or life-threating peripheral ischemia when given with CYP3A4 inhibitors, protease inhibitors, or macrolide antibiotics.
Caution: Brekiya may interact with other prescription and over-the-counter medications, including certain migraine therapies, antidepressants, antifungals, beta blockers, and substances such as grapefruit juice and nicotine.
Contraindications: hypersensitivity, pregnancy, severe renal failure, coronary vasospasm, ischemic heart disease, basilar or hemiplegic migraine.
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All the best.
Britt Talley Daniel MD
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