D.H.E. 45 Shortage Update: What Patients Need to Know in 2026

If you rely on D.H.E. 45 (dihydroergotamine mesylate injection) to treat migraines or cluster headaches, the ongoing shortage has almost certainly disrupted your life. Here is the most up-to-date overview of the situation, what it means for patients, and what practical steps you can take.

Current Shortage Status (2026)

As of 2026, dihydroergotamine mesylate injection remains on the ASHP (American Society of Health-System Pharmacists) drug shortage list. The shortage was formally created in August 2024, though supply instability began much earlier — with the 2022 discontinuation of the branded D.H.E. 45 product by Bausch Health.

The current market relies on two primary generic manufacturers:

Hikma Pharmaceuticals — Has product available, though it has experienced backorder periods.

Provepharm — Also has product available but experienced a significant backorder in late 2024 with an estimated December 2024 restock date.

Perrigo has fully discontinued their dihydroergotamine mesylate injection product, further shrinking the number of available suppliers. With only two manufacturers supplying the entire U.S. market, any production or shipping disruption at either company creates an immediate pharmacy-level shortage.

How Did the D.H.E. 45 Shortage Start?

The chain of events began in June 2022 when Bausch Health US, LLC notified the FDA it was discontinuing D.H.E. 45 — the brand that had been on the market since FDA first approved it in 1946. The FDA moved it to the Discontinued Drug Product List. Following FDA's February 2023 determination that the discontinuation was not for safety or effectiveness reasons, generic manufacturers could continue to produce the drug — but the market transition left a gap.

Perrigo subsequently also discontinued their generic formulation. What was once a multi-manufacturer market consolidated down to two suppliers — Hikma and Provepharm — both of which have at times been unable to maintain continuous supply.

Why Does a Drug Shortage Happen in the First Place?

Drug shortages in the U.S. are driven by a combination of factors:

Market consolidation — When few manufacturers make a drug, any disruption at one facility affects the whole market.

Low profit margins — Generic injectable drugs often have thin margins, discouraging investment in extra manufacturing capacity.

Manufacturing complexity — Injectable medications require sterile manufacturing environments that are expensive to build and maintain.

Distribution chain delays — Even when product is made, it can take weeks to flow from manufacturer to distributor to pharmacy.

Are There Newer DHE Options That Help?

Yes. Two new dihydroergotamine formulations received FDA approval in 2025, adding to the supply landscape:

Brekiya — The first DHE subcutaneous autoinjector; designed for patient self-administration at home with no refrigeration or assembly required.

Atzumi — A nasal powder formulation of DHE that provides another delivery option.

These products have their own separate supply chains and may be more consistently available than the generic injectable. However, they are brand-name products and cost more without insurance.

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What Should Patients Do Right Now?

Here are the most practical steps for patients dealing with the D.H.E. 45 shortage:

Don't wait until you're out of medication. Start searching for a refill 2–3 weeks before you run out. Shortage medications require more lead time.

Use a pharmacy locator service. medfinder calls pharmacies near you to find which ones have D.H.E. 45 in stock — saving you hours of calling around on your own.

Talk to your prescriber about an alternative. Ask for a backup prescription for a triptan or CGRP antagonist so you always have a treatment option available.

Ask about DHE nasal spray or autoinjector. These formulations have separate supply chains and may be easier to find.

Contact your insurer. During a documented shortage, insurance plans sometimes waive step therapy or prior authorization requirements to allow patients to access available alternatives.

For step-by-step guidance, see how to find D.H.E. 45 in stock near you and alternatives to D.H.E. 45.