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        New Message Board Archives >> Medications, Treatments, Therapies 2005 >> DHE IV protocol
        
(Message started by: Renee on Feb 2^nd, 2005, 6:25pm)

Title: DHE IV protocol
Post by Renee on Feb 2^nd, 2005, 6:25pm

Opinions please.

I have always been given DHE via IV with Reglan or Phenergan first and then the DHE pushed slowly over a 15 min. time period.

The quacks last night mixed the phenergan with the DHE and wanted to push the entire syringe in 2-3 minutes.

They refused to listen to me, especially when I refused nitro glycerin, so I walked out in fear of them screwing me up any further.

What/how have those of you who have had DHE via IV been administered?

I'd love to find something in writing and go shove it up their a**. But, maybe they are correct and I've always had it done over 15 minutes for no reason? :-X

Title: Re: DHE IV protocol
Post by eddie on Feb 2^nd, 2005, 6:33pm

unsolved1 would know he has had it done a few times
i wish you the best Renee you in are our prayers
PFwishes to ya
eddie :'(

Title: Re: DHE IV protocol
Post by E-Double on Feb 2^nd, 2005, 6:55pm

Dr. Robbins.......

http://www.headachedrugs.com/archives/outpatient_iv_dhe.html

not sure if helpful but first "hit" I got...will keep searching for ya!!

Title: Re: DHE IV protocol
Post by E-Double on Feb 2^nd, 2005, 7:03pm

http://www.guideline.gov/algorithm/2667/NGC_2667_4.pdf#search='DHE%20IV%20protocol'

Dr. Robbins....

Quote:

Repetitive IV DHE:
For patients with severe, frequent migraines or severe chronic daily headaches, repetitive IV DHE therapy has been very successful. Although usually performed in the hospital over 3 days, giving nine doses of DHE, the procedure may be done in the office without difficulty. Outpatient DHE allows this treatment to be available for those patients who do not wish to be hospitalized. IV DHE has proven very safe; serious side effects are rare, with only a few reported cases of claudication (that was reversible) and angina. The pharmacology of DHE is different than that of the other ergot preparations. It does not greatly constrict arteries, but is primarily a venoconstrictor. Serotonergic effects are most likely the mechanism of action. Although DHE is relatively safe for patients over the age of 50, caution must be used and lower doses given to those in older age ranges. Patients with peripheral vascular disease or heart disease must not be given DHE. DHE should be used with caution in patients with hypertension.

For the majority of patients, IV DHE has been successful in decreasing the intensity and frequency of headaches for a period of time. I have found that the effects of a course of DHE therapy usually last 1 or 2 months, with an occasional 6 or 8 month hiatus in the headaches. It is extremely effective for halting an acute migraine, as well as for preventing migraine attacks. Daily IM DHE is sometimes effective in preventing migraine.

Side Effects: The usual side effects are nausea, a hot feeling in the head, tightness in the throat or chest, leg and muscle cramps, and a transient rise in blood pressure. Because of the nausea, which is common, an antiemetic pill or injection is given half an hour prior to the DHE. The tightness in the throat or chest rapidly stops and does not present a serious problem, for it is of muscular or GI origin. An EKG should be done if this occurs. A transient muscle tension headache may ensue following the DHE, and diarrhea is occasionally a problem.

Office Protocol for IV DHE: The office protocol is as follows: give Reglan, one-half or one 10 mg. pill, with several Tums. One-half hour later, slowly give ½ mg. IV DHE. If well tolerated, give another ½ mg., for a total of 1 cc as the first dose. I do not usually utilize a hep-lock. If the first dose is well tolerated, as it usually is, the entire 1 mg. of DHE can be given at the next treatment. Patients may take the Reglan pill at home, prior to arriving for the DHE. Reglan is not usually very sedating, so that patients can drive, which is a tremendous advantage. The patient must be alert prior to driving after the DHE. If nausea is a problem, the dose is either lowered to ½ or ¾ mg., or stronger antiemetic medications are utilized. Phenergan, 25 mg. PO or IM, may be utilized. Alternatively, Vistaril, 25 mg. PO or IM, may be effective and is less sedating that Phenergan. Compazine, 10 to 25 mg. PO or 5 mg. IM, is a very effective antiemetic. Compazine may induce severe side effects (agitation or extrapyramidal reactions). Thorazine is a very effective medication to combat nausea, but with an increased incidence of side effects. Most patients are able to tolerate DHE with the Reglan as an antiemetic.

Blood pressure and pulse must be monitored before and after the DHE is given, and it is not unusual for the blood pressure to rise slightly after the DHE.

The office protocol is usually performed twice per day for 2 or 3 days, or a total of four to six doses.

Hospital Protocol for IV DHE: In the hospital, more doses may be administered in 1 day than in the office. We attempt to give a total of nine doses of DHE. The protocol is the same as in the office, beginning with only one pill of Reglan and, if necessary, progressing to stronger antiemetic medications. The goal is to utilize doses of DHE that are subnauseating. Detoxification from analgesics is somewhat easier in the hospital than as an outpatient. If needed, IV fluids may be given in the hospital. However, the overwhelming majority of patients greatly appreciate receiving DHE as outpatients.

In the hospital, doses of DHE are given at 8 hour intervals. If nausea is extreme and the other nausea medications have proved ineffective, Thorazine, 25 to 50 mg. IM, is administered prior to the DHE. Alternatively, Reglan or Compazine may be given intravenously for severe nausea. IV DHE is extremely effective for a variety of headache types, including migraine, tension, and cluster

Title: Re: DHE IV protocol
Post by Gator on Feb 2^nd, 2005, 11:55pm

I had been told that phenergan has bad interactions with DHE IV and should not be used. Hmmm. My neuro wanted me to do the DHE vacation thing, but I could not afford the hospital stay. The option of treatment in an outpatient setting, puts it a little closer to possible.

Title: Re: DHE IV protocol
Post by Renee on Feb 3^rd, 2005, 8:15am

Gator,

It is my understanding that the DHE and phenergan are not to be mixed in the same syringe as they become toxic. Of course, the idiot nurses I had a couple of days ago mixed them together. [smiley=huh.gif]

I came off that bed like a bolt of light and told them to pull that needle out before they inject any of it.

I've researched and found readings like above but no specifics on the phenergan mix.

I found a couple of readings that state a slow push over 3 minutes and other readings that state 15 minutes. [smiley=huh.gif]
:o

Title: Re: DHE IV protocol
Post by lionsound on Feb 3^rd, 2005, 9:28am

Hi Renee,
I believe you are so right. I Have a little card in my wallet given to me a from NECH that states what the ER is supposed to do for me.....do you have one? Of course the question should be does the ER bother to read it?

(it says that I am a patient being treated for migraine)
My card says ....we recommend the following for acute care...
and lists the phenergan, DHE and Decadron, then it says in italics

All of the above to be administered intramuscularly in three(3) separate syringes.

I know this is not via IV, but maybe they could give you something like that geared to you.

Sorry you had such a horrible experience, very glad you caught what was going on.

be well,
lionsound