1. Introduction
Zolmitriptan is a serotonin receptor agonist (5-HT1B/1D receptor agonist) used for the acute treatment of migraines, with or without aura. It works by narrowing blood vessels around the brain, reducing inflammation, and blocking pain signals. Zolmitriptan provides rapid relief from migraine symptoms but is not intended for migraine prevention.
2. Indications
- Acute treatment of migraines with or without aura in adults and adolescents (≥12 years).
- Treatment of cluster headaches (off-label use).
3. Dosage
Adults:
- Initial dose: 2.5 mg orally or via nasal spray at the onset of migraine.
- Maximum single dose: 5 mg.
- Repeat dose: If the migraine recurs, an additional dose may be taken after 2 hours.
- Maximum daily dose: 10 mg in 24 hours.
Children and Adolescents (12–17 years):
- Nasal spray: 2.5 mg as a single dose; repeat after 2 hours if needed.
- Maximum daily dose: 5 mg.
Elderly:
- Limited data available; start with the lowest effective dose and monitor closely.
4. Administration
- Take zolmitriptan as soon as migraine symptoms begin.
- Can be taken with or without food.
- The orally disintegrating tablet should be placed on the tongue to dissolve; no water is required.
- Do not exceed the recommended dose to avoid adverse effects.
5. Forms Available
- Tablets: 2.5 mg, 5 mg
- Orally disintegrating tablets: 2.5 mg, 5 mg
- Nasal spray: 2.5 mg, 5 mg
6. Side Effects
6.1 Common Side Effects:
- Dizziness
- Drowsiness
- Nausea
- Dry mouth
- Tingling sensations
6.2 Less Common Side Effects:
- Fatigue
- Weakness
- Chest discomfort (non-cardiac)
6.3 Rare but Serious Side Effects:
- Myocardial infarction or other cardiovascular events
- Serotonin syndrome (especially with other serotonergic drugs)
- Severe allergic reactions (e.g., rash, angioedema)
- Hypertensive crisis
7. Warnings
- Cardiovascular Risk: Contraindicated in patients with a history of ischaemic heart disease, uncontrolled hypertension, or significant cerebrovascular disease.
- Serotonin Syndrome: Risk increases when zolmitriptan is used with SSRIs, SNRIs, or other serotonergic drugs.
- Medication Overuse Headache (MOH): Frequent use may lead to worsening headaches.
- Basilar or Hemiplegic Migraines: Contraindicated due to the risk of vascular complications.
8. Precautions
- Use cautiously in patients with risk factors for coronary artery disease (e.g., smoking, diabetes, hyperlipidaemia).
- Avoid in patients with severe hepatic impairment, as zolmitriptan metabolism is significantly reduced.
- Do not combine with other triptans or ergotamine derivatives within 24 hours to reduce the risk of vasospastic reactions.
9. Interactions
- SSRIs/SNRIs: Increased risk of serotonin syndrome.
- MAO inhibitors: Contraindicated; avoid use within 2 weeks of discontinuing an MAO inhibitor.
- CYP1A2 inhibitors (e.g., fluvoxamine, cimetidine): Increased zolmitriptan plasma levels; dose adjustment may be required.
- Ergotamine and triptans: Avoid concomitant use due to additive vasoconstrictive effects.
10. Monitoring Parameters
- Assess for relief of migraine symptoms after administration.
- Monitor for signs of chest pain, tightness, or other cardiovascular symptoms.
- Observe for symptoms of serotonin syndrome, particularly in patients on serotonergic drugs.
- Evaluate usage patterns to prevent medication overuse headache (MOH).
11. Use in Children
- Approved for use in adolescents aged 12–17 years via nasal spray.
- Safety and efficacy in children under 12 years have not been established.
12. Use in Pregnancy
- Category C: Use only if the potential benefit outweighs the risks. Limited human data; animal studies show potential risks.
13. Use in Elderly
- Limited clinical data; use cautiously, starting at the lowest effective dose. Monitor for cardiovascular side effects.
14. Use in Kidney Disease
- No dose adjustment is required in mild to moderate renal impairment.
- Use cautiously in severe renal impairment.
15. Use in Liver Disease
- In patients with moderate hepatic impairment, the maximum dose should not exceed 2.5 mg.
- Contraindicated in severe hepatic impairment.
16. Patient Counselling Points
- Take zolmitriptan at the first sign of a migraine for best results.
- Do not use zolmitriptan to prevent migraines or for non-migraine headaches.
- Avoid taking more than the prescribed dose to prevent serious side effects.
- Report symptoms such as chest pain, tightness, or unusual fatigue to your doctor immediately.
- If you experience frequent migraines, consult your doctor about preventive treatments to avoid overuse.
17. Table of Brand Names, Manufacturer, and Prices in USD
Brand Name | Manufacturer | Strength/Dosage Form | Price (USD) |
---|---|---|---|
Zomig | AstraZeneca | 2.5 mg Tablet | $25 (1 tablet) |
Zomig ZMT | AstraZeneca | 2.5 mg Orally Disintegrating Tablet | $28 (1 tablet) |
Generic Zolmitriptan | Various | 2.5 mg Tablet | $10 (1 tablet) |
18. 15 FAQs (Frequently Asked Questions)
1. What is Zolmitriptan used for?
Zolmitriptan is used to treat acute migraines with or without aura.
2. How does Zolmitriptan work?
It narrows blood vessels in the brain and reduces inflammation, relieving migraine symptoms.
3. Can Zolmitriptan be used for cluster headaches?
It is sometimes used off-label for cluster headaches but consult your doctor for guidance.
4. How long does Zolmitriptan take to work?
Relief typically begins within 30–60 minutes after oral or nasal administration.
5. Can Zolmitriptan be used in children?
It is approved for adolescents aged 12–17 years via nasal spray.
6. Can Zolmitriptan prevent migraines?
No, it is not intended for migraine prevention.
7. Can I take Zolmitriptan with other painkillers?
Yes, it can be combined with simple analgesics like paracetamol or ibuprofen. Avoid combining with other triptans or ergotamines.
8. Can Zolmitriptan cause chest pain?
Yes, chest pain or tightness can occur and may indicate a serious cardiovascular reaction.
9. Is Zolmitriptan safe during pregnancy?
Use only if the potential benefits outweigh the risks. Consult your doctor.
10. Can I drive after taking Zolmitriptan?
Zolmitriptan may cause dizziness or drowsiness; avoid driving if affected.
11. Can Zolmitriptan cause serotonin syndrome?
Yes, especially if used with other serotonergic drugs like SSRIs or SNRIs.
12. How often can I take Zolmitriptan?
Do not exceed 2 doses (maximum 10 mg) in a 24-hour period.
13. Can Zolmitriptan be taken with food?
Yes, it can be taken with or without food.
14. What should I do if Zolmitriptan doesn’t work?
Consult your doctor; you may need a different treatment.
15. How should Zolmitriptan be stored?
Store at room temperature, away from moisture and heat.