What the FDA labels say about taking them together
Dihydroergotamine and itraconazole
Dihydroergotamine's FDA label of March 6, 2025 names itraconazole in its contraindications section, and itraconazole'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 itraconazole FDA label on DailyMed (effective July 13, 2026, Janssen Pharmaceuticals, Inc.).
What does the dihydroergotamine label say about itraconazole?
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 itraconazole label say about dihydroergotamine?
Itraconazole label, boxed warningSome examples of drugs that are contraindicated for coadministration with SPORANOX ® Capsules are: methadone, disopyramide, dofetilide, dronedarone, quinidine, isavuconazole, ergot alkaloids (such as dihydroergotamine, ergometrine (ergonovine), ergotamine, methylergometrine (methylergonovine)), irinotecan, lurasidone, oral midazolam, pimozide, triazolam, felodipine, nisoldipine, ivabradine, ranolazine, eplerenone, cisapride, naloxegol, lomitapide, lovastatin, simvastatin, avanafil, ticagrelor, finerenone, voclosporin.
Itraconazole label, drug interactionsAntimigraine Drugs Ergot alkaloids (e.g., dihydroergotamine, ergotamine) Contraindicated during and 2 weeks after SPORANOX ® treatment. Eletriptan Monitor for adverse reactions.
Source: FDA drug label (Tolsura, NDA208901), Mayne Pharma Commercial LLC, effective April 23, 2025 (SPL set 306352d1-9d5a-49ad-b72d-893b99546861), via openFDA
Source: FDA drug label (SPORANOX), Janssen Pharmaceuticals, Inc., effective July 13, 2026 (SPL set a4d555fa-787c-40fb-bb7d-b0d4f7318fd0), 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 | Itraconazole | |
|---|---|---|
| Labeled for | Migraine | Fungal infections |
| Boxed warning | Yes | Yes |
| Pharmacy cost (NADAC) | $29.44 per mL 4 mg/mL nasal spray | $0.910 per capsule 100 mg capsule |
| Shortage now | No current entry | A presentation being discontinued |
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