Why Is D.H.E. 45 So Hard to Find? [Explained for 2026]

If you've been prescribed D.H.E. 45 for migraines or cluster headaches and your pharmacy comes up empty, you're not imagining things — and you're definitely not alone. Dihydroergotamine mesylate, sold under the brand name D.H.E. 45, has been one of the most difficult-to-find injectable migraine medications in the United States for the past several years. Here's a clear explanation of why, and what options are available to you right now.

Is D.H.E. 45 Actually in Shortage?

Yes. The American Society of Health-System Pharmacists (ASHP) has maintained an active shortage listing for dihydroergotamine mesylate injection since August 2024. The shortage is real, widespread, and affects both hospitals and retail pharmacies across the country.

The problem has roots that go back to 2022 when Bausch Health — the original manufacturer of the D.H.E. 45 brand — formally notified the FDA that it was discontinuing the product. That decision triggered a cascade of supply problems that still ripples through the market today.

Why Did the Brand D.H.E. 45 Disappear?

In June 2022, Bausch Health US, LLC notified the FDA that D.H.E. 45 (dihydroergotamine mesylate injection, 1 mg/mL) was being discontinued. The company moved the product to the "Discontinued Drug Product List" section of the FDA Orange Book. Importantly, the FDA later confirmed — in response to a citizen petition — that D.H.E. 45 was not discontinued for safety or effectiveness reasons. The decision was business-driven, not medical.

That confirmation was significant: it meant that generic manufacturers could still get FDA approval for their own dihydroergotamine mesylate injection products. But transitioning the market from a single branded product to generics takes time — and in the meantime, patients struggled to find consistent supply.

Which Generic Manufacturers Supply the Market Now?

As of 2026, two generic manufacturers have dihydroergotamine mesylate injection available, though supply can be inconsistent:

Hikma Pharmaceuticals — Has dihydroergotamine injection available, though it has experienced back-order periods.

Provepharm — Also has product available, but has also experienced back-order periods (including a late 2024 backorder with estimated December 2024 restock).

Perrigo — Has discontinued their dihydroergotamine mesylate injection formulation, further reducing the number of available suppliers.

The result is a market with a small number of suppliers, any one of which going on backorder creates an immediate and significant impact on availability at the pharmacy level.

Are There Other Forms of Dihydroergotamine Available?

Yes — and this is an important piece of the picture. Dihydroergotamine (DHE) is available in several other formulations beyond the injectable:

Migranal (nasal spray, 0.5 mg/spray) — Brand name by Bausch Health; generic versions available.

Trudhesa (nasal spray, 0.725 mg/spray) — A higher-dose nasal spray by Impel that delivers DHE more deeply into the nasal cavity.

Brekiya (subcutaneous autoinjector) — FDA approved in 2025; designed for patient self-administration at home.

Atzumi (nasal powder) — Also FDA approved in 2025; offers an alternative delivery route.

These formulations have their own supply chains and may be more available than the injectable. If your prescription specifically calls for the injection form, talk to your doctor about whether a nasal spray or autoinjector could be a workable alternative.

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Why Does a Shortage of Injectable DHE Matter So Much?

For many patients, injectable dihydroergotamine is not interchangeable with oral or nasal alternatives. Patients with severe nausea and vomiting — a common feature of serious migraine attacks — cannot always use oral medications. The injectable form works faster and bypasses the digestive system entirely.

Hospitals and emergency departments also rely on IV dihydroergotamine for status migrainosus and refractory migraine protocols. When the drug is unavailable at the pharmacy level, it creates pressure up and down the entire healthcare supply chain.

What Can You Do Right Now If Your Pharmacy Is Out?

Here are the most effective steps to take:

Expand your pharmacy search. Don't just try one or two pharmacies. Try independent pharmacies, compounding pharmacies, and specialty pharmacies — they often source from different distributors and may have stock when chains don't.

Ask your doctor about formulation alternatives. Nasal sprays (Migranal, Trudhesa) or the Brekiya autoinjector may be clinically equivalent for your needs.

Use a pharmacy search service.

medfinder (medfinder.com) calls pharmacies near you to find out which ones have D.H.E. 45 in stock. Instead of spending hours on hold with pharmacies, you provide your medication details and location, and medfinder does the legwork. Results are sent directly to you by text.

Check if your insurer will help. During documented shortages, some insurance plans will waive step therapy requirements or prior authorizations to help you switch to an available alternative.

Skip the calls, skip the stress.

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Will the Shortage Be Resolved in 2026?

Predicting drug shortage resolution is notoriously difficult. The good news is that newer formulations — especially the Brekiya autoinjector and Atzumi nasal powder, both FDA approved in 2025 — add supply alternatives to the market. As the generic injectable supply chain stabilizes between Hikma and Provepharm, availability may become more consistent. However, with only two major generic suppliers, the drug will likely remain prone to localized shortages when either supplier has a manufacturing or distribution hiccup.

For the latest information, see our D.H.E. 45 shortage update for 2026 and our guide on how to find D.H.E. 45 in stock near you.