Zomig, Zomig ZMT, Zomig Nasal Spray
Classifications: serotonin 5-ht1 receptor agonist; Therapeutic: antimigraine; ergot alkaloid
Pregnancy Category: C
2.5 mg, 5 mg tablets orally disintegrating tablets; 5 mg nasal spray
Selective serotonin (5-HT1B/1D) receptor agonist. The agonist effects at 5-HT1B/1D reverse the vasodilation of cranial blood vessels and inhibit release of pro-inflammatory neuropeptides.
Vasoconstricts dilated cranial blood vessels and decreased neuropeptide release relieve the pain of a migraine headache.
Acute migraine headaches with or without aura.
Hypersensitivity to zolmitriptan; ischemic heart disease (angina pectoris, arteriosclerosis, ECG changes, history of MI
or Prinzmetal's angina); cardiac arrhythmias, symptomatic Wolff-Parkinson-White syndrome, uncontrolled hypertension; hemiplegia
or basilar migraine; concurrent administration of ergotamine or sumatriptan; PKU; adults >65 y; pregnancy (category C); children
Men >40 y; postmenopausal women; patients with other cardiac risk factors, such as diabetes, obesity, cigarette smoking,
high cholesterol levels, strong family history of CAD; concurrent administration of MAOIs; GI disease, PVD, ischemic colitis,
Raynaud's disease, cerebrovascular disease, stroke, intracranial bleeding; renal failure or renal disease; lactation.
Route & Dosage
Adult: PO 2.55 mg, may repeat in 2 h if necessary (max: 10 mg/24 h) Nasal Spray One spray into one nostril
- Give any time after symptoms of migraine appear. Give ≤2.5 mg by breaking
a 5 mg tablet in half. If headache returns, may repeat q2h up to 10 mg in 24 h.
- Do NOT give zolmitriptan within 24 h of an ergot-containing drug or other 5-HT1 agonist.
- Discard unused tablets that have been removed from the packaging.
- Unit-dose spray device delivers a 5 mg dose. Do not exceed the maximum dose of 10 mg in 24 h.
- Store at 2°25° C (36°77° F) and protect from light.
Adverse Effects (≥1%) Body as a Whole:
, pain, pressure sensation, paresthesia
, throat pressure, warm/cold sensations, hypesthesia. CNS:
Somnolence, dizziness, drowsiness, headache, hypesthesia, decreased mental acuity, euphoria, tremor. CV:
Coronary artery vasospasm, transient myocardial ischemia, MI,
ventricular tachycardia, ventricular fibrillation, chest pain/tightness/heaviness, palpitations. GI:
Dry mouth, nausea, vomiting. Respiratory: Dyspnea
InteractionsDrug: Dihydroergotamine, methysergide,
other 5-ht1 agonists
may cause prolonged vasospastic reactions; ssris
have rarely caused weakness, hyperreflexia, and incoordination; maoi
s should not be used with 5-ht1 agonists
of zolmitriptan. Herbal: St. John's wort
may increase triptan toxicity
Rapidly absorbed, 40% bioavailability. Peak:
23 h. Distribution:
25% protein bound. Metabolism:
In liver to active metabolite
Primarily in urine (65%), 30% in feces. Half-Life:
Assessment & Drug Effects
- Monitor for therapeutic effectiveness: Relief or reduction of migraine pain within 14 h.
- Monitor cardiovascular status carefully following first dose in patients at risk for CAD (e.g., postmenopausal women, men
>40 y, persons with known CAD risk factors) or coronary artery vasospasms.
- Perform periodic cardiovascular evaluation and ECG with long-term use.
- Report to physician immediately chest pain, nausea, or tightness in chest or throat that is severe or does not quickly resolve.
Patient & Family Education
- Carefully review patient information insert and guidelines for taking drug.
- Do NOT take zolmitriptan during the aura phase, but as early as possible after onset of migraine.
- Concurrent oral contraceptive use may increase incidence of adverse effects.
- Contact physician immediately if any of the following occur after zolmitriptan use: Symptoms of angina (e.g., severe or
persistent pain or tightness in chest or throat, sudden nausea), hypersensitivity (e.g., wheezing, facial swelling, skin
rash, hives), fainting, or abdominal pain.
- Report any other adverse effects (e.g., tingling, flushing, dizziness) at next physician visit.