Zolmitriptan

Zolmitriptan is a prescription medication used to treat migraine headaches once they have started. Zolmitriptan belongs to a group of drugs called serotonin receptor agonists or "triptans", which relieve pain by narrowing blood vessels around the brain.

This medication comes in tablet form. Swallow zolmitriptan tablets whole, with water.

It is also available as an orally disintegrating tablet that dissolves quickly in the mouth. It is found under the brand name Zolmig ZMT. 

Zolmitriptan is also available as a nasal spray. 

Common side effects of zolmitriptan include dizziness, drowsiness, dry mouth, and tingling skin. 

Zolmitriptan is a prescription medication used to treat migraine headaches in adults, once they have started.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Zolmitriptan may be found in some form under the following brand names:

• Zomig

Zolmitriptan is generally well tolerated. As with any medicine, people taking zolmitriptan may have side effects. The side effects are usually mild and do not last long.

The most common side effects of zolmitriptan nasal spray are:

• unusual taste, dry mouth
• tingling sensation, skin sensitivity, especially around the nose
• pain, pressure, and tightness sensations (eg, in the nose, throat, or chest)
• drowsiness, weakness, dizziness
• nausea

The most common side effects of zolmitriptan tablets and zolmitriptan orally disintegrating tablets are:

• pain, pressure or tightness in the neck, throat or jaw
• dizziness
• tingling or other abnormal sensations
• tiredness
• drowsiness
• feeling warm or cold
• nausea
• feeling of tightness or heaviness in other areas of the body
• dry mouth

In very rare cases, patients taking triptans may experience serious side effects, such as heart attacks, high blood pressure, stroke, or serious allergic reactions. Extremely rarely, patients have died. Call your doctor right away if you have any of the following problems after taking zolmitriptan:

• severe tightness, pain, pressure or heaviness in your chest, throat, neck, or jaw
• shortness of breath or wheezing
• sudden or severe stomach pain
• hives; tongue, mouth, or throat swelling
• problems seeing
• unusual weakness or numbness

Some people may have a reaction called serotonin syndrome, which can be life-threatening, when they use zolmitriptan. In particular, this reaction may occur when they use zolmitriptan together with certain types of antidepressants known as SSRIs or SNRIs. Symptoms may include mental changes (hallucinations, agitation, coma), fast heartbeat, changes in blood pressure, high body temperature or sweating, tight muscles, trouble walking, nausea, vomiting, and diarrhea. Call your doctor immediately if you have any of these symptoms after taking zolmitriptan.

This is not a complete list of side effects. Talk to your doctor if you develop any symptoms that concern you.

Tell your doctor about all the medicines you take or plan to take, including prescription and nonprescription medicines, supplements, and herbal remedies.

Tell your doctor if you are taking selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs), two types of drugs for depression or other disorders. Common SSRIs are:

• Celexa (citalopram)
• Lexapro (escitalopram)
• Paxil (paroxetine) 
• Prozac (fluoxetine) 
• Symbyax (olanzapine/fluoxetine)
• Zoloft (sertraline) 
• Sarafem (fluoxetine) 
• Luvox (fluvoxamine). 

Common SNRIs are Cymbalta (duloxetine) and Effexor (venlafaxine).

Your doctor will decide if you can take zolmitriptan with your other medicines.

Do not take zolmitriptan if you:

• Have heart disease or a history of heart disease
• Have uncontrolled high blood pressure
• Have hemiplegic or basilar migraine (if you are not sure about this, ask your doctor)
• Have or had a stroke or problems with your blood circulation
• Have serious liver problems
• Have taken any of the following medicines in the last 24 hours: other “triptans” like almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), sumatriptan/naproxen (Treximet); ergotamines like Bellergal-S, Cafergot, Ergomar, Wigraine; dihydroergotamine like D.H.E. 45 or Migranal; or methysergide (Sansert). These medications have side effects similar to zolmitriptan.
• Have taken monoamine oxidase (MAO) inhibitors such as phenelzine sulfate (Nardil) or tranylcypromine sulfate (Parnate) for depression or other conditions, or if it has been less than 2 weeks since you stopped taking a MAO inhibitor.
• Are allergic to any ingredients in zolmitriptan. 

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of zolmitriptan there are no specific foods that you must exclude from your diet when receiving zolmitriptan.

Tell your doctor about all the medicines you take or plan to take, including prescription and nonprescription medicines, supplements, and herbal remedies.

Tell your doctor if you:

• have heart disease or a history of heart disease
• have uncontrolled high blood pressure
• have hemiplegic or basilar migraine (if you are not sure about this, ask your doctor)
• have or had a stroke or problems with your blood circulation
• have serious liver problems
• have taken any of the following medications in the last 24 hours: almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), sumatriptan/naproxen (Treximet); ergotamines like Bellergal-S, Cafergot, Ergomar, Wigraine; dihydroergotamine like D.H.E. 45 or Migranal; or methysergide (Sansert). These medications have side effects similar to zolmitriptan.
• have taken monoamine oxidase (MAO) inhibitors such as phenelzine sulfate (Nardil) or tranylcypromine sulfate (Parnate) for depression or other conditions, or if it has been less than 2 weeks since you stopped taking a MAO inhibitor.

Tell your doctor if you know that you have any of the following risk factors for heart disease:

• high cholesterol
• diabetes
• smoking
• obesity (overweight)
• menopause
• a family history of heart disease or stroke

Tell your doctor if you are pregnant, planning to become pregnant, breast feeding, planning to breast feed, or not using effective birth control.

Tell your doctor if you are pregnant or plan to become pregnant. 

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Zolmitriptan falls into category C. No well-controlled studies have been done in humans. It is not known if zolmitriptan will harm your unborn baby. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

Tell your doctor if you are breastfeeding or plan to breastfeed.

It is not known if zolmitriptan is excreted in human breast milk or if it will harm your nursing baby. Because many drugs are excreted in human milk, caution should be exercised when zolmitriptan is administered to a nursing woman. 

Take zolmitriptan exactly as prescribed by your doctor. Take zolmitriptan exactly as your doctor tells you to take it. Your doctor will tell you how much zolmitriptan to take and when to take it.

Zolmitriptan comes in the following forms: tablet, tablets that dissolve on the tongue (brand name zolmitriptan ZMT), and nasal spray.

Take zolmitriptan as soon as a migraine starts.

If your headache comes back after your first dose, you may take a second dose anytime after 2 hours of taking the first dose. For any attack where the first dose did not work, do not take a second dose without talking with your doctor. Do not take more than a total of 10mg of zolmitriptan (tablets or spray combined in any 24 hour period. If you take too much medicine, contact your doctor, hospital emergency department, or poison control center right away.

Zolmitriptan tablets:

• Swallow zolmitriptan tablets whole with water or other liquid.

Zolmitriptan (orally disintegrating tablets):

• If you take zolmitriptan Orally Disintegrating tablets, do not remove the tablet from the blister pack until you are ready to take your medicine.
• You do not need to take any liquids with your Zomig ZMT Orally Disintegrating tablets.
• Take zolmitriptan Orally Disintegrating tablets whole.
• Place zolmitriptan Orally Disintegrating tablets on your tongue, where it will dissolve.
• Orally disintegrating tablets should be placed on the tongue where it will quickly dissolve, with no need for water.

Zolmitriptan Nasal Spray:

The zolmitriptan nasal spray device is a blue colored plastic sprayer device with a gray protection cap, labeled to indicate the dose. For adults, the usual dose is a single nasal spray taken into one nostril. If your headache comes back after your first dose, you may take a second dose anytime after 2 hours of taking the first dose. For any attack where the first dose didn’t work, do not take a second dose without talking with your doctor. Do not take more than a total of 10 mg of zolmitriptan (tablets or spray combined) in any 24-hour period. If you take too much medicine, contact your doctor, hospital emergency department, or poison control center right away.

The zolmitriptan nasal spray device consists of the following parts:

A. The Tip: This is the part that you put into your nostril. The medicine comes out of a tiny hole in the top.

B. The Protective Cap: This covers the tip to protect it. Do not remove the protective cap until just before you are ready to take your zolmitriptan nasal spray.

C. The Finger-grip: This is the part that you hold when you use the sprayer.

D. The Plunger: This is the part that you press when you put the tip into your nostril. This sprayer works only once.

Steps for using zolmitriptan nasal spray:

1. Blow your nose gently before use. Remove the protective cap (B). Hold the nasal sprayer device gently with your fingers and thumb as shown in the picture to the right. There is only one dose in the nasal sprayer. Do not try to prime the nasal sprayer or you will lose the dose. Do not press the plunger until you have put the tip into your nostril or you will lose the dose.

2. Block one nostril by pressing firmly on the side of your nose. Either nostril can be used. Put the tip (A) of the sprayer device into the other nostril as far as feels comfortable and tilt your head slightly as shown in the picture to the right.

Do not press the plunger yet.

Do not spray the contents of the device in your eyes.

3. Breathe in gently through your nose and at the same time press the plunger (D) firmly with your thumb. The plunger may feel stiff and you may hear a click. Keep your head slightly tilted back and remove the tip from your nose. Breathe gently through your mouth for 5-10 seconds. You may feel liquid in your nose or the back of your throat. This is normal and will soon pass.

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The dose your doctor recommends may be based on the following:

• other medical conditions you have
• how you respond to this medication
• your liver function

Zolmitriptan Nasal Spray

For adults, the usual dose is a single nasal spray (5 mg) taken into one nostril. If your headache comes back after your first dose, you may take a second dose anytime after 2 hours of taking the first dose.

• For any attack where the first dose didn’t work, do not take a second dose without talking with your doctor.
• Do not take more than a total of 10 mg of zolmitriptan (tablets or spray combined) in any 24-hour period.
• If you take too much medicine, contact your doctor, hospital emergency department, or poison control center right away

Zolmitriptan tablets

The recommended starting dose range of zolmitriptan is 1.25 mg-2.5mg.

If the headache returns, the dose may be repeated after 2 hours, not to exceed 10 mg within a 24-hour period.

Zolmitriptan Orally Disintegrating Tablets

The recommended dose range is 2.5 mg-5 mg.

If the headache returns, the dose may be repeated after 2 hours, not to exceed 10 mg within a 24-hour period.

If you take too much zolmitriptan, call your local Poison Control Center or seek emergency medical attention right away.

Store your medication at controlled room temperature, 20-25°C (68-77°F), and away from children.

Discard after use or when it expires.