Migranal ratings & reviews

Migranal contains dihydroergotamine mesylate in the form of a mesylate salt. It is a nasal spray intended for intranasal administration, provided as a clear, colorless to light yellow aqueous solution.

How should I use this medication?

This medication is for use in the nose. Take it as directed on the prescription label. Do not use it more often than directed. Make sure that you are using your nasal spray correctly. Ask your care team if you have any questions.

A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.

Talk to your care team about the use of this medication in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

This does not apply. This medication is not for regular use. It should only be used as needed.

Where should I keep my medication?

Keep out of the reach of children and pets.

Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F). Do not freeze. Do not refrigerate. Protect from light. Get rid of any unused medication 8 hours after priming the spray.

To get rid of medications that are no longer needed or have expired:

• Take the medication to a medication take-back program. Check with your pharmacy or law enforcement to find a location.
• If you cannot return the medication, check the label or package insert to see if the medication should be thrown out in the garbage or flushed down the toilet. If you are not sure, ask your care team. If it is safe to put it in the trash, take the medication out of the container. Mix the medication with cat litter, dirt, coffee grounds, or other unwanted substance. Seal the mixture in a bag or container. Put it in the trash.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

What side effects may I notice from receiving this medication?

Side effects that you should report to your care team as soon as possible:

• Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
• Burning, pain, tingling, or color changes in the hands, arms, legs, or feet
• Dry cough, shortness of breath or trouble breathing
• Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
• Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
• Increase in blood pressure
• Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
• Sudden or severe stomach pain, bloody diarrhea, fever, nausea, vomiting
• Pain in the lower back or sides

Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):

• Change in taste
• Diarrhea
• Dizziness
• Irritation inside the mouth or throat
• Nausea
• Runny or stuffy nose
• Vomiting

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What should I tell my care team before I take this medication?

They need to know if you have any of these conditions:

• Chest pain
• Diabetes
• Having or recent surgery
• Have had a heart attack, stroke, or mini-stroke
• Heart or blood vessel conditions
• High blood pressure
• High cholesterol
• Infection
• Kidney disease
• Liver disease
• Tobacco use
• An unusual or allergic reaction to dihydroergotamine, other medications, foods, dyes, or preservatives
• Pregnant or trying to get pregnant
• Breastfeeding

What may interact with this medication?

Do not take this medication with any of the following:

• Bromocriptine
• Chloramphenicol
• Clarithromycin
• Cocaine
• Letermovir
• Levoketoconazole
• Lonafarnib
• Mifepristone
• Nefazodone
• Other medications that constrict blood vessels or increase blood pressure, such as dopamine, droxidopa, ephedrine, epinephrine, isoproterenol, midodrine, norepinephrine, phenylephrine, pseudoephedrine
• Some medications for cancer, such as adagrasib, ceritinib, idelalisib, ribociclib, tucatinib
• Some antivirals for HIV or hepatitis
• Some medications for fungal infections, such as itraconazole, ketoconazole, posaconazole, voriconazole
• Triptans, such as almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan

This medication may also interact with the following:

• Beta-blockers, such as metoprolol or propranolol
• Grapefruit juice
• Fluconazole
• Nicotine
• SSRIs, medications for depression, such as citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
• Zileuton

Other medications may affect the way this medication works. Talk with your care team about all the medications you take. They may suggest changes to your treatment plan to lower the risk of side effects and to make sure your medications work as intended.

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medication?

Visit your care team for regular checks on your progress. Tell your care team if your symptoms do not start to get better or if they get worse.

This medication may affect your coordination, reaction time, or judgment. Do not drive or operate machinery until you know how this medication affects you. Sit up or stand slowly to reduce the risk of dizzy or fainting spells. Drinking alcohol with this medication can increase the risk of these side effects.

Tell your care team right away if you notice unexplained wounds on your fingers or toes while taking this medication. You should also tell your care team if you experience numbness or pain, changes in the skin color, or sensitivity to temperature in your fingers or toes.

If you take migraine medications for 10 or more days a month, your migraines may get worse. Keep a diary of headache days and medication use. Contact your care team if your migraine attacks occur more frequently.

Talk to your care team if you may be pregnant. This medication can cause preterm labor.

Do not breastfeed while taking this medication and for 3 days after the last dose.

What are the most serious risks of this medication?

This medication can cause serious side effects by reducing blood flow to parts of the body, such as the hands and feet. This can happen if you take it with certain other medications. Talk to your care team about all the medications and supplements you take. They can tell you what is safe to take together. Talk to your care team right away if you have burning, pain, tingling, or color changes in the hands, arms, legs, or feet. Call emergency services if you have sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, or loss of balance or coordination.