Dihydroergotamine Injection and Sumatriptan: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Sumatriptan
Dihydroergotamine Injection
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased risk of coronary artery vasospasm
Interaction Deep Dive
Concurrent use of SUMAtriptan and an ergot-containing drugs may cause an additive vasospastic reaction5. One case has been reported where concurrent use of ergotamine and SUMAtriptan was associated with cerebellar infarction in a 24-year-old female with no evidence of vascular anomaly 2. Another case report describes the sudden death of a 58-year old female who had been prescribed both methysergide and SUMAtriptan 4. Use of SUMAtriptan within 24 hours of an ergot preparation, such as dihydroergotamine, is contraindicated 15.
Why it happens (mechanism)
Additive vasoconstrictive effects
Literature reports
3 reports — tap to read
a) A 24-year-old migraine patient suffered a cerebellar infarction after concurrent use of ergotamine and SUMAtriptan. The CT scan found no vascular anomalies. Early symptoms included ataxia, dizziness, bradycardia, sweating, and vomiting. The patient later became aphasic and then unresponsive. Because the patient was young, otherwise healthy, and had no vascular anomalies, the infarction was likely the result of an interaction between SUMAtriptan and ergotamine 2.
b) Thirty-eight patients were pretreated with dihydroergotamine, followed by SUMAtriptan 2 or 4 mg subcutaneously. While dihydroergotamine alone caused 13 and 9 mm Hg maximal increases in systolic and diastolic blood pressures, respectively, SUMAtriptan alone caused 7 and 6 mm Hg increases in these values. Treatment with both drugs resulted in changes no different than those observed with either drug alone 3.
c) A 58-year old female who had been taking methysergide prophylactically for seven years was on her annual break from the drug when she experienced a migraine headache. She took a dose of SUMAtriptan and developed chest pain and vomiting within three hours, with the outcome being fatal. The time frame between the doses of methysergide and SUMAtriptan is not specified. The female had also been recently diagnosed with rheumatic mitral stenosis, and ischemic heart disease was revealed during autopsy 4.
Common questions
Can I take Dihydroergotamine Injection and Sumatriptan together?
Increased risk of coronary artery vasospasm Always confirm with your pharmacist or prescriber before making any change.
How serious is the Dihydroergotamine Injection and Sumatriptan interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Dihydroergotamine Injection or Sumatriptan need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (5)
- Product Information: Migranal(R) nasal spray, dihydroergotamine mesylate nasal spray. Bausch Health US LLC (per FDA), Bridgewater, NJ, 2022. DailyMed
- Anon: Cave ergotamin (Migrexa U.A.) plus sumatriptan (Imigran). Arznei-Telegramm 1994; 3/94:32.
- Fowler PA, Lacey LF, Thomas M, et al: The clinical pharmacology, pharmacokinetics and metabolism of sumatriptan. Eur Neurol 1991; 31:291-294. PubMed
- Anon: Fatal outcomes after sumatriptan. Aust Adv Drug React Bull 1997; 16:15.
- Product Information: Imitrex(R), sumatriptan. Glaxo Wellcome Inc. Research Triangle Park, NC, 1998. DailyMed
Keep reading about Sumatriptan
Keep reading about Dihydroergotamine Injection
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