Dihydroergotamine (DHE-45) is a very old migraine drug in the family of ergot alkaloids. It is one of the most effective migraine drugs when it is given intravenously and it is often used when patients are admitted to the hospital for migraines that do not respond to other therapies.
Dihydroergotamine (DHE) is also available as a nasal spray (Migranal), but it works well only in a limited number of patients and is very expensive. This poor consistency of effect is partly due to the amount of liquid that needs to be sprayed for one dose, most of which is either swallowed or leaks out. A form of DHE to be inhaled into the lungs had been in development for many years, but is not likely to become available due to manufacturing difficulties.
A promising new way to deliver DHE as a nasal powder is being developed by Satsuma Pharmaceuticals. The company presented their preliminary data at the recently concluded scientific meeting of the American Headache Society in Philadelphia. Their study showed that powdered form of DHE delivered into the nose gets into the blood faster and better than the existing nasal liquid form, although not as well as when it is given as an intramuscular injection. The device to administer DHE is small and easy to use, unlike another device that is also being developed for intranasal delivery of DHE powder. The company is initiating a large clinical trial, which will hopefully lead to the approval of their product.
