Always discuss with headache fellow or attending prior to administration
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Scenario #1: Start with10mg Reglan and then in 20 minutes give 0.5mg of DHE
- If tolerated, and HA resolves give DHE 0.5mg q8 hours
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Scenario #2: Start with 10mg Reglan and then in 20 minutes give 0.5mg of DHE
If tolerated, but HA remains 1 hour after first dose of DHE, give 0.5mg DHE again
If2nd dose tolerated give 1mg q8 hours starting 8 hours after 1st dose
If 2nd dose not tolerated give 10mg of Reglan then in 8 hours give 0.75mg DHE and continue 0.75mg q8.
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Scenario #3: Start with 10mg Reglan and then in 20 minutes give 0.5mg of DHE
- If after first 0.5 mg patient gets very sick in 8 hours give 0.25mg DHE and try that every 8 hours. You can also dilute the dose further in more NS volume and administer very slowly, but d/w fellow or attending how to best manage side effects
Note: Often after the first few doses patients can tolerate larger doses of DHE so it's worth retrying a higher dose after a dose or two of DHE. Sometimes people tolerate it better if it's run more slowly (over 30-45 minutes). Another option is to do continuous infusion of DHE over 24 hours-mix 3mg in 1000mL NS and run at 41 mL/hr