Drug interactions
Dihydroergotamine + Diltiazem
Severity: Major
Dihydroergotamine and Diltiazem: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Dihydroergotamine is metabolized by CYP3A4, and CYP3A4 inhibitors raise its levels with a risk of ergotism. This can cause severe peripheral and cerebral vasospasm and ischemia. The risk is established with strong inhibitors and is less well defined with moderate inhibitors such as diltiazem.
What this interaction means in plain words
Dihydroergotamine and Diltiazem can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Dihydroergotamine belongs to Central Nervous System; Diltiazem belongs to Cardiovascular.
Why it happens
Diltiazem inhibits CYP3A4 and reduces dihydroergotamine clearance, adding to vasoconstriction risk.
What to do
Avoid the combination where possible and choose an alternative migraine therapy. If it is used, monitor for numbness, coldness, paresthesias and ischemic symptoms and stop dihydroergotamine if they occur.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Dihydroergotamine and Diltiazem, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
Other interactions of Diltiazem
- Diltiazem + Flibanserin Contraindicated
- Diltiazem + Ivabradine Contraindicated
- Diltiazem + Lomitapide Contraindicated
- Diltiazem + Lonafarnib Contraindicated
- Acebutolol + Diltiazem Major
- Alfentanil + Diltiazem Major
Other interactions of Dihydroergotamine
- Almotriptan + Dihydroergotamine Contraindicated
- Clarithromycin + Dihydroergotamine Contraindicated
- Dihydroergotamine + Dopamine Contraindicated
- Dihydroergotamine + Dronedarone Contraindicated
- Dihydroergotamine + Efavirenz Contraindicated
- Dihydroergotamine + Eletriptan Contraindicated
Frequently asked questions
Can I take Dihydroergotamine with Diltiazem?
MediHelp rates the interaction as major. Dihydroergotamine and Diltiazem can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Dihydroergotamine is metabolized by CYP3A4, and CYP3A4 inhibitors raise its levels with a risk of ergotism. This can cause severe peripheral and cerebral vasospasm and ischemia. The risk is established with strong inhibitors and is less well defined with moderate inhibitors such as diltiazem.
How serious is the interaction between Dihydroergotamine and Diltiazem?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible and choose an alternative migraine therapy. If it is used, monitor for numbness, coldness, paresthesias and ischemic symptoms and stop dihydroergotamine if they occur.
What other medicines interact with Diltiazem?
MediHelp also lists interactions of Diltiazem with, for example, Flibanserin, Ivabradine, Lomitapide. The full list is on the Diltiazem page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
