What the FDA labels say about taking them together
Dihydroergotamine and erythromycin
Dihydroergotamine's FDA label of March 6, 2025 names erythromycin in its contraindications section, and erythromycin's label names dihydroergotamine too. The dihydroergotamine label: “The use of potent CYP 3A4 inhibitors with dihydroergotamine is, therefore contraindicated.”
Check it at the source: the dihydroergotamine FDA label on DailyMed (effective March 6, 2025, Oceanside Pharmaceuticals); the erythromycin FDA label on DailyMed (effective August 1, 2024, Teva Pharmaceuticals USA, Inc.).
What does the dihydroergotamine label say about erythromycin?
Dihydroergotamine label, contraindicationsThe use of potent CYP 3A4 inhibitors (ritonavir, nelfinavir, indinavir, erythromycin, clarithromycin, troleandomycin, ketoconazole, itraconazole) with dihydroergotamine is, therefore contraindicated ( see WARNINGS, CYP 3A4 Inhibitors ).
Dihydroergotamine label, warningsThe use of potent CYP 3A4 inhibitors with dihydroergotamine should therefore be avoided ( see CONTRAINDICATIONS ). Examples of some of the more potent CYP 3A4 inhibitors include: antifungals ketoconazole and itraconazole, the protease inhibitors ritonavir, nelfinavir, and indinavir, and macrolide antibiotics erythromycin, clarithromycin, and troleandomycin.
Trudhesa label (Impel Pharmaceuticals LLC, September 3, 2026), contraindicationsCONTRAINDICATIONS TRUDHESA is contraindicated in patients: with concomitant use of strong CYP3A4 inhibitors, such as protease inhibitors (e.g., ritonavir, nelfinavir, or indinavir), macrolide antibiotics (e.g., erythromycin or clarithromycin), and antifungals (ketoconazole or itraconazole) [see Warnings and Precautions (5.1) and Drug Interactions (7.1) ] with ischemic heart disease (angina pectoris, history of myocardial infarction, or documented silent ischemia) or patients who have clinical symptoms or findings consistent with coronary artery vasospasm, including Prinzmetal's variant angina [see Warnings and Precautions (5.4) ] with uncontrolled hypertension [see Warnings and Precautions …
Trudhesa label (Impel Pharmaceuticals LLC, September 3, 2026), drug interactionsThere have been rare reports of serious adverse events in connection with the coadministration of intravenous administration of dihydroergotamine and strong CYP3A4 inhibitors, such as protease inhibitors (e.g., ritonavir, nelfinavir, indinavir), macrolide antibiotics (e.g., erythromycin, clarithromycin), and antifungals (e.g., ketoconazole, itraconazole), resulting in vasospasm that led to cerebral ischemia and/or ischemia of the extremities [see Warnings and Precautions (5.1) ].
Source: FDA drug label (Trudhesa, NDA213436), Impel Pharmaceuticals LLC, effective September 3, 2026 (SPL set b81397b0-910d-4eb4-8fee-a9a3c9d94d63), via openFDA
Source: FDA drug label (Dihydroergotamine Mesylate), NDA020148 (Bausch), as published by Oceanside Pharmaceuticals, effective March 6, 2025 (SPL set 977de209-c53a-4cb4-9f3f-1e850600a9dc), via openFDA; the full label on DailyMed
What does the erythromycin label say about dihydroergotamine?
Erythromycin label, contraindicationsErythromycin is contraindicated in patients taking terfenadine, astemizole, cisapride, pimozide, ergotamine, or dihydroergotamine (see PRECAUTIONS - Drug Interactions ).
Erythromycin label, drug interactionsErgotamine/dihydroergotamine Post-marketing reports indicate that co-administration of erythromycin with ergotamine or dihydroergotamine has been associated with acute ergot toxicity characterized by vasospasm and ischemia of the extremities and other tissues including the central nervous system.
Source: FDA drug label (Erythrocin Lactobionate, NDA050609), Hospira, Inc., effective October 30, 2025 (SPL set a96c405f-bd70-4bb4-719e-ac6a79dcc213), via openFDA
Source: FDA drug label (Erythromycin, NDA050536), Dr. Reddy's Labratories Inc., effective September 25, 2025 (SPL set a2dcb48a-212c-1b0c-ec35-ee2ade85847f), via openFDA
Source: FDA drug label (Erythromycin), Teva Pharmaceuticals USA, Inc., effective August 1, 2024 (SPL set 75a0bd5a-d09f-483b-bfd8-f8343b149eb2), via openFDA; the full label on DailyMed
These are the labels' own sentences. PlainMeds does not grade interactions; a pharmacist or prescriber can say what they mean for one person's medicines.
Both medicines on the record
| Dihydroergotamine | Erythromycin | |
|---|---|---|
| Labeled for | Migraine | Bacterial infections, Acne |
| Boxed warning | Yes | No |
| Pharmacy cost (NADAC) | $29.44 per mL 4 mg/mL nasal spray | $1.96 per tablet 250 mg tablet |
| Shortage now | No current entry | No current entry |
Source: FDA NDC Directory, CMS NADAC of October 7, 2026 and the FDA Drug Shortage Database (FDA files October 8, 2026)
What next?
- Check more medicines together
- up to five at once