Two medicines, side by side
Dihydroergotamine vs zolmitriptan
Dihydroergotamine and zolmitriptan are both labeled for migraine. Drugs@FDA records approvals of dihydroergotamine since 1946 and of zolmitriptan since 1997. Pharmacies paid $29.44 per mL (Dihydroergotamine mesylate 4 mg/mL nasal spray) and $1.02 per zolmitriptan 2.5 mg tablet (NADAC, October 7, 2026); the strengths differ, so the two prices are not like for like. In FDA's classes, dihydroergotamine is an ergotamine derivative and zolmitriptan a serotonin-1b and serotonin-1d receptor agonist.
Check it at the source: the dihydroergotamine FDA label on DailyMed (effective March 6, 2025); the zolmitriptan FDA label on DailyMed (effective January 29, 2026).
Highlights of the dihydroergotamine record
Dihydroergotamine (Trudhesa) · label of March 6, 2025
PERIPHERAL ISCHEMIA FOLLOWING COADMINISTRATION WITH POTENT CYP3A4 INHIBITORS Serious and/or life-threatening peripheral ischemia has been associated with the coadministration of DIHYDROERGOTAMINE with potent CYP 3A4 inhibitors including protease inhibitors and macrolide antibiotics. Because CYP 3A4 inhibition elevates the serum levels of DIHYDROERGOTAMINE, the risk for vasospasm leading to cerebral ischemia and/or ischemia of the extremities is increased.
Used for
From the label: indicationsDihydroergotamine Mesylate Nasal Spray is indicated for the acute treatment of migraine headaches with or without aura. Dihydroergotamine Mesylate Nasal Spray is not intended for the prophylactic therapy of migraine or for the management of hemiplegic or basilar migraine.
On the market
- Earliest approval on file
- April 12, 1946
- Generic labelers
- 9 labelers
- Pharmacy cost
- $29.44 per mL
Supply and safety
- Shortage
- No current entry
- Recalls
- 2
Highlights of the zolmitriptan record
Zolmitriptan (Zomig) · label of January 29, 2026
Used for
From the label: indicationsZolmitriptan tablets are indicated for the acute treatment of migraine with or without aura in adults. Limitations of Use • Only use zolmitriptan tablets if a clear diagnosis of migraine has been established. If a patient has no response to zolmitriptan tablets treatment for the first migraine attack, reconsider the diagnosis of migraine before zolmitriptan tablets are administered to treat any subsequent attacks. […]
On the market
- Earliest approval on file
- November 25, 1997
- Generic labelers
- 20 labelers
- Pharmacy cost
- $1.02 per tablet
Supply and safety
- Shortage
- No current entry
- Recalls
- 0
Source: FDA drug labels via openFDA (Dihydroergotamine label of March 6, 2025, Zolmitriptan label of January 29, 2026); NDC Directory, Drugs@FDA, NADAC, FDA shortages and recalls (October 8, 2026)
How do dihydroergotamine and zolmitriptan differ on the record?
In FDA's classes, dihydroergotamine is an ergotamine derivative and zolmitriptan a serotonin-1b and serotonin-1d receptor agonist.
How each works, in its label's words: Dihydroergotamine, “Mechanism of Action Dihydroergotamine binds with high affinity to 5-HT 1Dα and 5-HT 1Dβ receptors.”; Zolmitriptan, “Zolmitriptan binds with high affinity to human recombinant 5-HT 1D and 5-HT 1B receptors, and moderate affinity for 5-HT 1A receptors.”
Only the dihydroergotamine label carries a boxed warning.
Generics: dihydroergotamine since 2003; zolmitriptan since 2013 (Drugs@FDA).
| Dihydroergotamine | Zolmitriptan | |
|---|---|---|
| Labeled for | Migraine | Migraine |
| Pharmacologic class | Ergotamine Derivative | Serotonin-1b and Serotonin-1d Receptor Agonist |
| How it works (label) | Mechanism of Action Dihydroergotamine binds with high affinity to 5-HT 1Dα and 5-HT 1Dβ receptors. | Zolmitriptan binds with high affinity to human recombinant 5-HT 1D and 5-HT 1B receptors, and moderate affinity for 5-HT 1A receptors. |
| Half-life (label) | The decline of plasma dihydroergotamine is biphasic with a terminal half-life of about 10 hours. | n/a |
| Earliest approval on file (Drugs@FDA) | April 12, 1946 | November 25, 1997 |
| First generic approved | April 28, 2003 | May 14, 2013 |
| Generic labelers (NDC) | 9 labelers | 20 labelers |
| Pharmacy cost (NADAC, each one's most listed form; strengths differ) | $29.44 per mL (Dihydroergotamine mesylate 4 mg/mL nasal spray) | $1.02 per tablet (Zolmitriptan 2.5 mg tablet) |
| 12-month price change | -10% | -20% |
| Boxed warning | Yes | No |
| Shortage now | No current entry | No current entry |
| Recalls recorded | 2 | 0 |
| FAERS reports (a report is not proof of cause; counts follow how widely a medicine is used) | 1,270 | 7,155 |
| DEA schedule | none | none |
Source: Drugs@FDA, FDA NDC Directory, CMS NADAC of October 7, 2026, FDA shortages and recalls, FAERS via openFDA (FDA files October 8, 2026)
What next?
- Alternatives to dihydroergotamine
- every medicine labeled for the same conditions