Zolmitriptan

DEA Class; Rx

Common Brand Names; Zomig, Zomig Rapimelt, Zomig-ZMT

• Serotonin 5-HT-Receptor Agonists; 
• Antimigraine Agents

Hypersensitivity

History of myocardial infarction

Ischemic or vasospastic artery disease, including Prinzmetal variant angina or other significant underlying cardiovascular disease

Uncontrolled HTN

Wolff-Parkinson-White syndrome or arrhythmias associated with other cardiac accessory conduction pathway disorders

Peripheral vascular disease

Ischemic bowel disease

Not indicated for basilar or hemiplegic migraine

Do not use concurrently with or within 2 wk of using MAO Inhibitors

Recent use (ie, within 24 hr) of another 5-HT1 agonist, ergotamine-containing medication, or ergot-type medication (such as dihydroergotamine or methysergide)

History of stroke

Transient ischemic attack, or history of hemiplegic or basilar migraine

• Dizziness (6-10%)
• Neck/throat/jaw pain (4-10%)
• Parasthesia (5-9%)
• Nausea (4-9%)
• Weakness (3-9%)
• Somnolence (5-8%)
• Warm/cold sensation (5-7%)
• Xerostomia (3-5%)
• Chest pain (2-4%)
• Diaphoresis (3%)
• Pain (2-3%)
• Dyspepsia (1-3%)
• Dysphagia (2%)
• Myasthenia (2%)
• Palpation (2%)
• Vertigo (2%)
• Hypoesthesia (1-2%)
• Myalgia (1-2%)

Little added benefit with 5 mg PO dose compared with 2.5 mg

Coronary artery vasospasm, myocardial infarction, transient ischemia, ventricular tachycardia/fibrillation, cardiac arrest, and death reported with use

In patients who experience symptoms or signs suggestive of a vasospastic reaction following the use of any 5-HT1 agonist, rule out a vasospastic reaction before receiving additional doses

Overuse of acute migraine drugs (eg, ergotamine, triptans, opioids, or combination of these drugs for ≥10 days/month) may lead to exacerbation of headache (medication overuse headache)

As with other 5-HT1 agonists, sensations of tightness, pain, pressure, and heaviness in the precordium, throat, neck, and jaw commonly occur that are not cardiac in origin

Cerebral hemorrhage, subarachnoid hemorrhage, and stroke have occurred with 5-HT1 agonists, including some fatalities

Before treating headaches in patients not previously diagnosed as migraineurs, and in migraineurs who present with symptoms atypical for migraine, exclude other potentially serious neurological conditions; drug is contraindicated in patients with a history of stroke or transient ischemic attack

May cause noncoronary vasospastic reactions (eg, peripheral vascular ischemia, GI vascular ischemia and infarction, splenic infarction, and Raynaud’s syndrome

Significant elevation in blood pressure, including hypertensive crisis reported in patients with and without history of hypertension; monitor blood pressure in patients receiving therapy

Potentially life-threatening serotonin syndrome may occur, particularly during combined use with SSRIs (eg, fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, escitalopram) or SNRIs (eg, venlafaxine, duloxetine); discontinue therapy if serotonin syndrome suspected

Partial vision loss and blindness (transient and permanent) reported with 5-HT1 agonists

Use caution in elderly patients, who are more likely to have underlying cardiovascular disease and hepatic or renal impairment; cardiovascular evaluation recommended in patients with other cardiovascular risk factors prior to initiation of therapy

Therapy is indicated for acute treatment of migraine headache; not for migraine prophylaxis

There are no adequate data on the developmental risk associated with the use in pregnant women

There are no data on presence of drug or metabolites in human milk, effects on the breastfed infant, or on milk production