Question about DHE-45

[delano2000]

To all who can answer...

Today I was at the hospital shadowing a pharmacist and a doctor prescribed DHE-45 to be administered through IV piggyback, instead of the usual IV flush, over 15-30 mins. My question is, is it possible to administer it this way? If I am not mistaken it should be undiluted. But isn't it too small of a volume to have it administered over 15-30 mins if you can't dilute it?

 

[Praziquantel86]

What was the indication? It typically is used as a push for migraines to achieve a more rapid onset of effect. If it was being used off-label for something that didn't require rapid onset, diluting it and administering it over a longer period of time would help to relieve sme of the pain caused by the high alcohol content.

 

[crazybob]

http://www.rxlist.com/dhe-45-drug.htm
http://www.healthsquare.com/drugs/85656.htm

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=5842

Your doctor will have told you what dose to use for each migraine attack. Should you get another migraine attack in the same day as the attack you treated, you must not treat it with D.H.E. 45® (dihydroergotamine mesylate) Injection, USP unless at least 6 hours have elapsed since your last injection. No more than 6 mL of D.H.E. 45® (dihydroergotamine mesylate) Injection, USP should be injected during a one-week period. Do not use more than this amount unless instructed to do so by your doctor. D.H.E. 45® (dihydroergotamine mesylate) Injection, USP is not intended for chronic daily use.

as long as it's not an overdose, patients will be fine.

 

[delano2000]

What was the indication? It typically is used as a push for migraines to achieve a more rapid onset of effect. If it was being used off-label for something that didn't require rapid onset, diluting it and administering it over a longer period of time would help to relieve sme of the pain caused by the high alcohol content.

I honestly don't remember the indication (wished I looked at it thoroughly)...the pharmacists had a hard time trying to figure it out. I remember, however, that it did not state what solution to mix it in, whether in normal saline, 5% dextrose etc, or if it should even be mixed in a solution...the way it came off was that it should be administered directly from the little bottle but over 15-30 mins which kinda seems impossible to do...what do you think

 

[metrarx]

I honestly don't remember the indication (wished I looked at it thoroughly)...the pharmacists had a hard time trying to figure it out. I remember, however, that it did not state what solution to mix it in, whether in normal saline, 5% dextrose etc, or if it should even be mixed in a solution...the way it came off was that it should be administered directly from the little bottle but over 15-30 mins which kinda seems impossible to do...what do you think

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[metrarx]

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[delano2000]

Where are you getting that it's supposed to be administered over 15-30 min?

You can do it over 1-2 min

if it was done 1-2 mins that is understandable...the order from the doctor stated that it should be administered over 15-30 mins

 

[delano2000]

Maybe you're confusing the 15-20 min flush with direct injection?

I think you flush for that long prior to continuous IV infusion but someone correct me if I'm wrong

it said to be administered IV piggyback

 

[metrarx]

....

 

[delano2000]

-Direct injection over 1-2 minutes

-Continuous infusion in L bag over 24 hours (max 3 mg)

-Intermittent (in your case): 50-100 mL NS/D5W over 15-30 minutes


scratch what I said about IV flush.

see this right here makes sense...thanks for the input