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Overview: Atzumi is a powder that is inhaled into your nose and is used to treat acute migraines. It works by helping reduce pain and inflammation. Common side effects include runny nose, nausea, change in how things taste, and irritation inside your nose. Serious side effects may include high blood pressure, blood flow problems, and heart problems. Tell your health care provider about all of your medical conditions and all medicines and supplements you use before using Atzumi. Atzumi interacts with many medicines, which can lead to serious side effects.

Uses

What is Atzumi used for?

Atzumi (dihydroergotamine) is commonly used to treat migraine, with or without aura. 

Atzumi may also be used for other conditions as determined by your health care provider.

How does Atzumi work (mechanism of action)?

During a migraine, it is thought that the blood vessels in the brain widen, causing pain and swelling. There may also be changes in brain chemicals, such as serotonin. Atzumi may work by targeting serotonin receptors in the brain, which may help narrow the blood vessels and reduce pain and inflammation.

How is Atzumi supplied (dosage forms)?

Brands and other names

  • Atzumi

Dosage forms and strengths

  • 5.2 mg nasal powder

How should I store Atzumi?

Atzumi should be stored at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place. Keep Atzumi in its foil pouch until you are ready to use it.

Side Effects

What are the most common side effects of Atzumi?

The most common side effects of Atzumi are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Runny nose
  • Nausea or vomiting
  • Change in how things taste
  • Nasal irritation (see below)
  • Dizziness
  • Sleepiness
  • Sore throat
  • Diarrhea

There may be other side effects of Atzumi that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of Atzumi?

While less common, the most serious side effects of Atzumi are described below, along with what to do if they happen.

Severe Allergic Reactions. Atzumi may cause allergic reactions, which can be serious. Stop using Atzumi and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching or skin rash
  • Bumps on the skin called hives that can be red, pink, white, or brown depending on your skin tone
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Heart Attack, Other Heart Problems, and Stroke. Atzumi may increase your risk of heart attack, other heart problems (such as an abnormal heart rhythm), and stroke, which can lead to death. You may be at higher risk of these problems if you have risk factors for heart disease. Stop using Atzumi and get emergency help if you have any of the following symptoms.

  • Chest pain, pressure, or tightness
  • Fast or abnormal heartbeat
  • Trouble breathing or shortness of breath
  • Pain in your back, neck, jaw, throat, or stomach
  • Unusual sweating
  • Nausea or vomiting
  • Feeling dizzy or lightheaded
  • Weakness or numbness on one side of your body
  • Loss of vision in one or both eyes
  • Sudden, severe headache with no known cause
  • Slurred speech or trouble understanding speech

Blood Flow Problems. Atzumi can reduce blood flow to many areas of the body, which can be serious. Stop using Atzumi and tell your health care provider right away if you have any of the following symptoms.

  • Tingling, numbness, or change in color of fingers or toes
  • Muscle pain or weakness
  • Sudden or severe stomach pain 
  • Weight loss
  • Constipation or diarrhea
  • Nausea or vomiting
  • Fever

Increased Blood Pressure (Hypertension). Atzumi may increase your blood pressure or make it worse if you have a history of high blood pressure. Call your health care provider if your blood pressure increases while using this medicine.

If you measure your blood pressure and the top number (systolic) is 180 mm Hg or higher or the bottom number (diastolic) is 120 mm Hg or higher, get medical attention right away. Increases in blood pressure may not be noticeable, but look out for and tell your health care provider right away if you have any of the following symptoms of severely high blood pressure.

  • Sudden severe headache
  • Chest pain
  • Dizziness or confusion
  • Trouble breathing
  • Nausea or vomiting
  • Blurry or other changes to vision
  • Anxiety
  • Buzzing in the ears
  • Nosebleed
  • Feeling of skipped heartbeats

Medicine Overuse Headache. Using Atzumi more often than prescribed may cause your headaches to happen more often or get worse. This is called medicine overuse headache or rebound headache. Keep track of how often you have headaches and how often you use Atzumi. Tell your health care provider if your headaches are getting worse. 

Tissue Changes. Atzumi can cause a buildup of scar tissue and inflammation around the lungs, stomach, or other organs, which is called fibrosis. This can happen in people using this medicine daily on a long-term basis. Do not use more medicine than prescribed. 

Nasal Irritation. Atzumi can cause irritation inside your nose, which can sometimes be severe. Tell your health care provider if you have any of the following symptoms that bother you. 

  • Nasal discomfort
  • Change in taste or smell
  • Runny, stuffy, or itchy nose
  • Sneezing or cough
  • Nosebleed
  • Watery eyes

Warnings & Precautions

Who should not use Atzumi?

Allergies to Ingredients. People who are allergic to any of the following should not use Atzumi.

  • Atzumi
  • Dihydroergotamine
  • Any other medicine known as an ergot alkaloid
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in Atzumi.

Drug Interactions. Atzumi should not be used while you are using certain other medicines. Using Atzumi with certain medicines can cause severe blood flow problems to your feet or legs. This is a serious condition called peripheral ischemia, which can lead to symptoms such as cramping, pain, tingling, weakness, or heaviness in your legs or feet. It may also lead to stroke or death. Before using Atzumi, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Heart Problems or Uncontrolled High Blood Pressure. Atzumi should not be used if you have or have had heart problems, including chest pain (angina), a heart attack, or coronary artery vasospasm. It should also not be used if you have uncontrolled high blood pressure. Tell your health care provider if you have any of these problems.

Blood Vessel Problems. Atzumi should not be used if you have certain problems with your arteries or veins (peripheral vascular disease) or if you have had surgery on your blood vessels. Discuss these issues with your health care provider to help them decide if you can use Atzumi.

Kidney Problems. Atzumi should not be used if your kidneys are not working as well as they should be. If there is a concern about the health of your kidneys, your health care provider may do tests to see if they are working well enough to use this medicine.

Liver Problems. Atzumi should not be used if your liver is not working as well as it should be. If there is a concern about the health of your liver, your health care provider may do tests to see if it is working well enough to use this medicine.

What should I know about Atzumi before using it?

Do not use Atzumi unless it has been prescribed to you by a health care provider. Use it as prescribed. Do not use more of this medicine than prescribed. Using it more often than prescribed may increase the risk of serious side effects. See the Side Effects section for more details.

Do not share Atzumi with other people, even if they have the same condition as you. It may harm them.

Keep Atzumi out of the reach of children.

Atzumi is powder that you inhale into your nose. Read and follow the instructions and make sure that you understand how to properly prepare and use Atzumi. Knowing how to use Atzumi before you need it may be helpful when you are having a migraine. If you have any questions, talk to your health care provider.

It may be helpful to keep a headache journal where you write down when you get your headaches and when you use Atzumi. This information could be shared with your health care provider to see how the medicine is working for you.

Atzumi should not be used to prevent migraine. 

Not all headaches can be treated with Atzumi. In particular, hemiplegic and basilar headaches should not be treated with Atzumi. Talk with your health care provider if you are unsure if you have these types of headaches.

What should I tell my health care provider before using Atzumi?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if Atzumi is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your health care provider if you have any of the following.

  • Heart problems or a history of heart problems
  • High blood pressure
  • Risk factors for heart disease, such as high cholesterol, smoking, diabetes, or a family history of heart disease
  • Kidney or liver problems
  • Blood flow problems, including peripheral vascular disease or Raynaud’s syndrome
  • Stomach or intestinal problems

Pregnancy. Atzumi may cause premature labor and should be avoided during pregnancy. Tell your health care provider right away if you are pregnant or plan to become pregnant.

Breastfeeding. Do not breastfeed while you are using Atzumi and for 3 days after your last dose. Atzumi may pass into breast milk and reduce your breast milk supply. Tell your health care provider if you are breastfeeding or plan to breastfeed.

How can I get more information about Atzumi?

For more information about Atzumi, you can visit the drugmaker’s website at www.atzumi.com or call them at 888-273-2480.

Interactions

Does Atzumi interact with foods or drinks?

Atzumi can interact with grapefruit juice. Tell your health care provider if you eat grapefruit or drink grapefruit juice before using Atzumi.

It is unknown if drinking alcohol will affect Atzumi. The risk of dizziness or sleepiness may be increased if you drink alcohol while using Atzumi.

Does Atzumi interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using Atzumi.

  • A macrolide antibiotic, such as clarithromycin or erythromycin (Ery-Tab and others), which is a medicine used for bacterial infections
  • Fluconazole (Diflucan), itraconazole (Sporanox, Tolsura), ketoconazole, posaconazole (Noxafil), or voriconazole (Vfend), which is a medicine used for fungal infections
  • A protease inhibitor, such as nelfinavir (Viracept) or ritonavir (Norvir), which is a medicine commonly used to treat HIV
  • A triptan, such as eletriptan (Relpax), sumatriptan (Imitrex and others), and others, which is a medicine commonly used to treat migraines
  • Any other ergot, such as dihydroergotamine (Migranal, Trudhesa, and others) or ergotamine (Ergomar), which is a medicine used to treat migraine
  • A vasoconstrictor, such as phenylephrine, pseudoephedrine, or xylometazoline for nasal congestion, which is a medicine that can cause blood vessels to narrow
  • A beta-blocker, such as atenolol (Tenormin), metoprolol (Lopressor, Toprol XL, and others), or propranolol (Inderal LA, Innopran XL), which is a medicine that may be used for certain heart conditions or to lower blood pressure
  • Diltiazem (Cardizem CD and others) or verapamil (Verelan, Verelan PM), which is a medicine used for high blood pressure or other conditions
  • Nicotine, which can be found in cigarettes, vapes, or products that help you stop smoking
  • A selective serotonin reuptake inhibitor (SSRI), such as fluoxetine, paroxetine, or sertraline, which is a medicine commonly used for anxiety and depression
  • Nefazodone, which is a medicine used to treat depression
  • Zileuton, which is a medicine used to treat asthma

Many other medicines may alter the blood levels of Atzumi. Tell your health care provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with Atzumi. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much Atzumi?

If you or someone else has used too much Atzumi, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of Atzumi?

Atzumi is meant to be used only when needed. Use it as your health care provider recommends. Do not use more than 2 doses of Atzumi within 24 hours.