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DHE Protocol Flow Chart

Dihydroergotamine (DHE-45) Protocol

(from Gelb)

  1. Place heparin-lock needle upon arrival of patient.
  2. Order DHE-45 and metoclopramide (Reglan) to the floor stat.
  3. Give 10 mg Reglan i.v. followed immediately by 0.5 mg DHE given over 2 minutes. If, in the next hour, nausea, appears or headache disappears, give no further medications until 10 p.m. and order 0.5 mg DHE + 10 mg Reglan q 8 h. If nausea does not occur and headache persists, give another 0.5 mg DHE i.v. (without Reglan) one hour after the first 0.5 mg dose and order 1.0 mg DHE + 10 mg Reglan q 8 h. In either case, the next dose should be given at 10 p.m. so that the q 8 h schedule is maintained at 6 a.m. - 2 p.m. - 10 p.m.
  4. After 5 doses have been given, Reglan may be discontinued.
  5. After the patient is rendered headache-free, DHE subcutaneously at 1.0 mg q 8 h may be substituted along with nursing lessons in s.q. injections. At discharge, DHE suppositories (2 mg) may be ordered (5) as a possible substitute. The ordering of the suppository requires a non-formulary requisition.
  6. Lomotil is usually necessary for the diarrhea that may attend DHE administration or codeine withdrawal; the average dosage is 2-3 tablets q 6 h prn.
  7. Morhpine, 4 mg i.v. - one time only - may be ordered for the first 24 hours.
  8. Pentobarbital 150 mg i.m. h.s. for selected patients.

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