9 mins read

Overview: Brekiya is an injection that is given under the skin to treat acute migraines and cluster headaches. It works by helping reduce pain and inflammation. 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 Brekiya. Brekiya interacts with many medicines, which can lead to serious side effects.

Uses

What is Brekiya used for?

Brekiya (dihydroergotamine) is commonly used to treat the following conditions. 

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

How does Brekiya work (mechanism of action)?

Migraine and cluster headaches likely have different causes, but both may involve a widening of blood vessels in the brain, which can lead to pain and inflammation. There may also be changes in brain chemicals, such as serotonin. Brekiya may work by targeting serotonin receptors in the brain, which may help narrow the blood vessels and reduce pain and inflammation.

How is Brekiya supplied (dosage forms)?

Brands and other names

  • Brekiya

Dosage forms and strengths

  • 1 mg/mL prefilled single-dose autoinjector

How should I store Brekiya?

Brekiya 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 and protect from light. Do not refrigerate or freeze. Keep Brekiya in its original packaging until you are ready to use it.

Side Effects

What are the most common side effects of Brekiya?

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

  • Blood flow problems (see below)
  • Heart problems (see below)

There may be other side effects of Brekiya 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 Brekiya?

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

Severe Allergic Reactions. Brekiya may cause allergic reactions, which can be serious. Stop using Brekiya 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. Brekiya 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 Brekiya 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. Brekiya can reduce blood flow to many areas of the body, which can be serious. Stop using Brekiya 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). Brekiya 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 Brekiya 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 Brekiya. Tell your health care provider if your headaches are getting worse. 

Tissue Changes. Brekiya 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. 

Warnings & Precautions

Who should not use Brekiya?

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

  • Brekiya 
  • Dihydroergotamine
  • Latex
  • 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 Brekiya.

Drug Interactions. Brekiya should not be used while you are using certain other medicines. Using Brekiya 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 Brekiya, 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. Brekiya 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. Brekiya 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 Brekiya.

Kidney Problems. Brekiya 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. Brekiya 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 Brekiya before using it?

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

Keep Brekiya out of the reach of children.

Brekiya is medicine that is injected under the skin (subcutaneous). Read and follow the instructions and make sure that you understand how to properly prepare and use Brekiya. Knowing how to use Brekiya before you need it may be helpful when you are having a migraine or cluster headache. 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 Brekiya. This information could be shared with your health care provider to see how the medicine is working for you.

Brekiya should not be used to prevent migraine. 

Not all headaches can be treated with Brekiya. In particular, hemiplegic and basilar headaches should not be treated with Brekiya. 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 Brekiya?

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 Brekiya 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
  • Latex allergy

Pregnancy. Brekiya 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 Brekiya and for 3 days after your last dose. Brekiya 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 Brekiya?

For more information about Brekiya, you can visit the drugmaker’s website at www.brekiya.com or call them at (877) 835-5472.

Interactions

Does Brekiya interact with foods or drinks?

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

It is unknown if drinking alcohol will affect Brekiya. 

Does Brekiya 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 Brekiya.

  • 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 Brekiya. 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 Brekiya. 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 Brekiya?

If you or someone else has used too much Brekiya, 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 Brekiya?

Brekiya is meant to be used only when needed. Use it as your health care provider recommends. Do not use more than 3 doses of Brekiya within 24 hours.