Propranolol and Dihydroergotamine Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Dihydroergotamine Injection
Propranolol
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
Coadministration of dihydroergotamine and propranolol may potentiate vasoconstriction45 because the combination may cause synergistic elevation of blood pressure 2. Potentiation of vasoconstrictive action of ergotamine may be caused by blocking vasodilating property of EPINEPHrine 31.
Why it happens (mechanism)
Additive vasoconstrictive effects; blockade of vasodilating property of EPINEPHrine
Literature reports
1 report — tap to read
a) A normotensive 26 year-old female was on prophylactic propranolol for migraine headaches. During an acute migraine attack, prochlorperazine 5 mg and dihydroergotamine 0.75 mg were administered intravenously. The patient immediately became hypertensive and complained of a crushing substernal chest pain. Her blood pressure was measured to be 180/120 mm Hg and her free T4 level was 4.7 ng/dL. No evidence of a myocardial infarction was present. The combination of the patient's hyperthyroidism and the administration of dihydroergotamine and propranolol all contributed to her vasoconstrictive episode 5.
Common questions
Can I take Propranolol and Dihydroergotamine Injection together?
Increased risk of coronary artery vasospasm Always confirm with your pharmacist or prescriber before making any change.
How serious is the Propranolol and Dihydroergotamine Injection interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
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 "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Propranolol or Dihydroergotamine Injection 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: ATZUMI(R) nasal powder, dihydroergotamine nasal powder. Satsuma Pharmaceuticals (per Manufacturer), Durham, NC, 2025. DailyMed
- Product Information: BREKIYA(R) subcutaneous injection, dihydroergotamine mesylate subcutaneous injection. Amneal Pharmaceuticals (Per Manufacturer), Bridgewater, NJ, 2025. DailyMed
- Product Information: TRUDHESA(TM) nasal spray, dihydroergotamine mesylate nasal spray. Impel NeuroPharma Inc (per DailyMed), Seattle, WA, 2021. DailyMed
- Product Information: D.H.E. 45(R) intravenous, intramuscular, subcutaneous injection, dihydroergotamine mesylate intravenous, intramuscular, subcutaneous injection. Valeant Pharmaceuticals North America LLC (per DailyMed), Bridgewater, NJ, 2017.
- Gandy W: Dihydroergotamine interaction with propranolol (letter). Ann Emerg Med 1990; 19:221.
Keep reading about Dihydroergotamine Injection
Keep reading about Propranolol
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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