What is Zolmitriptan

Zolmitriptan is used to treat the symptoms of migraine headaches (severe throbbing headaches that sometimes are accompanied by nausea and sensitivity to sound and light). Zolmitriptan is in a class of medications called selective serotonin receptor agonists. It works by narrowing blood vessels around the brain, stopping pain signals from being sent to the brain, and blocking the release of certain natural substances that cause pain, nausea, and other symptoms of migraine. Zolmitriptan does not prevent migraine attacks or reduce the number of headaches you have.

Zolmitriptan is available only with your doctor’s prescription.

Zolmitriptan comes as a tablet and an orally disintegrating tablet (tablet that dissolves quickly in the mouth) to take by mouth. It is usually taken at the first sign of a migraine headache. If your symptoms improve after you take zolmitriptan but return after 2 hours or longer, you may take a second tablet. However, if your symptoms do not improve after you take zolmitriptan, do not take a second tablet without calling your doctor. Your doctor will tell you the maximum number of tablets or orally disintegrating tablets you may take in a 24-hour period. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take zolmitriptan exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

You may take your first dose of zolmitriptan in a doctor’s office or other medical facility where you can be monitored for serious reactions.

If your doctor has prescribed a dose lower than 2.5 mg, you may use your fingers to break the 2.5-mg tablet on the line that divides it in half. However, you should not break or split the orally disintegrating tablet.

To take the orally disintegrating tablet, use dry hands to peel back the foil packaging. Immediately take out the tablet and place it on your tongue. The tablet will quickly dissolve and can be swallowed with saliva. No water is needed to swallow disintegrating tablets. Do not open the foil packaging or remove the orally disintegrating tablet until just before you are ready to take it.

Call your doctor if your headaches do not get better or occur more frequently after taking zolmitriptan.

If you take zolmitriptan more often or for longer than the recommended period of time, your headaches may get worse or may occur more frequently. You should not take zolmitriptan or any other headache medication for more than 10 days per month. Call your doctor if you need to take zolmitriptan to treat more than three headaches in a 1-month period.

Zolmitriptan has caused serious side effects in some people, especially people who have heart or blood vessel disease. Be sure that you discuss with your doctor the risks of using this medicine as well as the benefits that it can do.

What is zolmitriptan used for?

Zolmitriptan is used to treat acute migraine headaches in adults. Zolmitriptan is not used to prevent migraine headaches and is not used for cluster headaches. Zolmitriptan works in the brain to relieve the pain from migraine headaches. Zolmitriptan belongs to the group of medicines called triptans.

Many people find that their headaches go away completely after they take zolmitriptan. Other people find that their headaches are much less painful, and that they are able to go back to their normal activities even though their headaches are not completely gone. Zolmitriptan often relieves symptoms that occur together with a migraine headache, such as nausea, vomiting, sensitivity to light, and sensitivity to sound.

Zolmitriptan is not an ordinary pain reliever. It should not be used to relieve any kind of pain other than migraine headaches. This medicine is usually used for people whose headaches are not relieved by acetaminophen, aspirin, or other pain relievers.

The triptans are synthetic serotonin receptor agonists that are used in the therapy of migraine and vascular headache. Serotonin (5-hydroxytryptamine or 5-HT) is a monoamine that has multiple actions, acting as a neurotransmitter and bioactive amine. The diversity of actions of serotonin is partially due to the multitude of different serotonin receptors and their tissue location. There are at least 15 classes of serotonin receptors which have overlapping actions, but variable distribution and intracellular pathways of response to stimulation and inhibition. The triptans are serotonin agonists with high affinity for the 5-HT1B and 5-HT1D receptors which are found on smooth-muscle cells of blood vessels. Simulation of the 5-HT1D receptor results in constriction of intracranial blood vessels. The triptans may also block the release of vasoactive peptides from perivascular trigeminal neurons through their action at presynaptic 5-HT1D receptors on nerve terminals. Regardless, the triptans have been found to be effective in preventing or aborting migraine headaches with shortening of the period of pain and symptoms. The triptans are considered “first line” agents for patients whose vascular headaches do not reliably respond to conventional analgesics. They generally have a more rapid onset of action and fewer side effects than the ergot alkaloids. Seven triptans are approved for use in the United States including almotriptan, eletriptan, forvatriptan, naratriptan, rizatriptan, sumatriptan and zolmitriptan. Generic formulations are available for most agents. The short acting triptans include sumatriptan, almotriptan, eletriptan, rizatriptan and rolmitriptan and generally provide relief within 30 to 60 minutes. The longer activing oral triptans include naratriptan and frovatriptan which have a slower onset of action but may be better tolerated. Intranasal formulations may have a more rapid onset of action as do subcutaneous administered forms.

Zolmitriptan special precautions

Before taking zolmitriptan:

• tell your doctor and pharmacist if you are allergic to zolmitriptan, any other medications, or any of the ingredients in zolmitriptan tablets or orally disintegrating tablets. Ask your pharmacist for a list of the ingredients.
• do not take zolmitriptan if you have taken any of the following medications in the past 24 hours: other selective serotonin receptor agonists such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), or sumatriptan (Imitrex, in Treximet); or ergot-type medications such as bromocriptine (Parlodel), cabergoline , dihydroergotamine (D.H.E. 45, Migranal), ergoloid mesylates (Hydergine), ergonovine (Ergotrate), ergotamine (Cafergot, Ergomar, Wigraine), methylergonovine (Methergine), methysergide (Sansert), and pergolide (Permax).
• do not take zolmitriptan if you are taking a monoamine oxidase A (MAO-A) inhibitor such as isocarboxazid (Marplan), phenelzine (Parnate), or tranylcypromine (Nardil) or if you have taken one of these medications in the past 2 weeks.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, or herbal products you are taking or plan to take. Be sure to mention any of the following: acetaminophen (Tylenol); antidepressants such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); cimetidine (Tagamet); oral contraceptives (‘birth control pills’); propranolol (Inderal); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft); and selective serotonin/norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Pristiq), duloxetine (Cymbalta), sibutramine (Meridia), and venlafaxine (Effexor). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have or have ever had heart disease; a heart attack; angina (chest pain); irregular heartbeats; stroke or ‘mini-stroke’; or circulation problems such as varicose veins, blood clots in the legs, Raynaud’s disease (problems with blood flow to the fingers, toes, ears, and nose), or ischemic bowel disease (bloody diarrhea and stomach pain caused by decreased blood flow to the intestines). Your doctor may tell you not to take zolmitriptan.
• tell your doctor if you smoke or are overweight; if you have or have ever had high blood pressure, high cholesterol, diabetes, or liver or kidney disease; if you have gone through menopause (change of life); or if any family members have or have ever had heart disease or stroke.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you plan to be sexually active while you are taking this medication, talk to your doctor about effective methods of birth control. If you become pregnant while taking zolmitriptan, call your doctor.
• you should know that this medication may make you drowsy or dizzy. Do not drive a car or operate machinery until you know how zolmitriptan affects you.
• talk to your doctor about your headache symptoms to make sure they are caused by migraine. Zolmitriptan should not be used to treat certain types of migraine headaches (hemiplegic or basilar) or other types of headaches (such as cluster headaches).
• if you have phenylketonuria (PKU, an inherited condition in which a special diet must be followed to prevent mental retardation), you should know that the orally disintegrating tablets contain aspartame that forms phenylalanine.

Pregnancy

Pregnancy Category C: Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking zolmitriptan, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using zolmitriptan with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Almotriptan
• Bromocriptine
• Cisapride
• Dihydroergotamine
• Eletriptan
• Ergoloid Mesylates
• Ergonovine
• Ergotamine
• Frovatriptan
• Isocarboxazid
• Levomethadyl
• Linezolid
• Mesoridazine
• Methylene Blue
• Methylergonovine
• Methysergide
• Naratriptan
• Phenelzine
• Procarbazine
• Rizatriptan
• Sumatriptan
• Terfenadine
• Thioridazine
• Tranylcypromine

Using zolmitriptan with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Acecainide
• Ajmaline
• Alfentanil
• Amiodarone
• Amitriptyline
• Amoxapine
• Amphetamine
• Aprindine
• Azimilide
• Benzhydrocodone
• Benzphetamine
• Bretylium
• Chloroquine
• Citalopram
• Codeine
• Desipramine
• Desvenlafaxine
• Dextroamphetamine
• Dibenzepin
• Dihydrocodeine
• Disopyramide
• Dofetilide
• Dolasetron
• Doxepin
• Droperidol
• Duloxetine
• Erythromycin
• Escitalopram
• Fentanyl
• Flecainide
• Fluconazole
• Fluoxetine
• Fluvoxamine
• Foscarnet
• Gemifloxacin
• Granisetron
• Halofantrine
• Hydrocodone
• Hydromorphone
• Hydroquinidine
• Ibutilide
• Imipramine
• Isradipine
• Levomilnacipran
• Levorphanol
• Lidoflazine
• Lisdexamfetamine
• Lithium
• Lorcainide
• Lorcaserin
• Mefloquine
• Meperidine
• Metaxalone
• Methadone
• Methamphetamine
• Milnacipran
• Mirtazapine
• Morphine
• Morphine Sulfate Liposome
• Nefazodone
• Nortriptyline
• Octreotide
• Oxycodone
• Oxymorphone
• Palonosetron
• Paroxetine
• Pentamidine
• Pirmenol
• Pixantrone
• Prajmaline
• Probucol
• Procainamide
• Prochlorperazine
• Propafenone
• Protriptyline
• Quinidine
• Reboxetine
• Remifentanil
• Sematilide
• Sertraline
• Sibutramine
• Sotalol
• Spiramycin
• St John’s Wort
• Sufentanil
• Tapentadol
• Tedisamil
• Tramadol
• Trazodone
• Trifluoperazine
• Trimipramine
• Vasopressin
• Venlafaxine
• Vilazodone
• Vortioxetine
• Ziprasidone

Using zolmitriptan with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Cimetidine

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using zolmitriptan with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use zolmitriptan, or give you special instructions about the use of food, alcohol, or tobacco.

• Tobacco

Other Medical Problems

The presence of other medical problems may affect the use of zolmitriptan. Make sure you tell your doctor if you have any other medical problems, especially:

• Angina (chest pain) or
• Arrhythmia (heart rhythm problem) or
• Basilar migraine (migraine with vision and hearing problems), history of or
• Heart attack, history of or
• Heart or blood vessel disease or
• Hemiplegic migraine (migraine with some paralysis), history of or
• Hypertension (high blood pressure), uncontrolled or
• Ischemic bowel disease (bowels have low blood supply) or
• Peripheral vascular disease (clogged arteries) or
• Stroke, history of or
• Transient ischemic attack (TIA), history of or
• Wolff-Parkinson-White Syndrome (heart rhythm problem)—Should not be used in patients with these conditions.
• Coronary artery disease, family history of or
• Diabetes or
• Hypertension (high blood pressure) or
• Obesity or
• Raynaud’s syndrome—Use with caution. May be at increased risk for certain side effects.
• Heart rhythm problems (e.g., ventricular fibrillation, ventricular tachycardia)—Use with caution. May make these conditions worse.
• Liver disease, moderate to severe—Use of oral disintegrating tablet is not recommended in patients with this condition because these tablets should not be broken in half.
• Phenylketonuria (PKU)—The oral disintegrating tablets contains phenylalanine, which can make your condition worse.

Zolmitriptan dosage

The dose of zolmitriptan will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of zolmitriptan. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of zolmitriptan that you take depends on the strength of the zolmitriptan. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using zolmitriptan.

For oral dosage forms (oral tablets):

• For migraine headaches:
  • Adults—At first, 1.25 or 2.5 milligrams (mg) (tablet may be broken in half) as a single dose. If the migraine comes back after being relieved, another dose may be taken if at least 2 hours have passed since the first dose. Do not take more than 5 mg in a single dose, or 10 mg in any 24-hour period.
  • Children—Use is not recommended.

For oral dosage form (oral disintegrating tablets):

• For migraine headaches:
  • Adults—2.5 mg placed on top of your tongue. If the migraine comes back after being relieved, another dose may be taken if at least 2 have passed since the first dose. Do not take more than 5 mg in a single dose or 10 mg in any 24-hour period.
  • Children—Use is not recommended.

Zolmitriptan side effects

Zolmitriptan may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• feeling warm or cold
• drowsiness
• dry mouth
• nausea
• heartburn
• sweating
• dizziness or faintness

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment:

• pain, tightness, pressure, or heaviness in the chest, throat, neck, or jaw
• slow or difficult speech
• weakness or numbness of an arm or leg
• fast, pounding, or irregular heartbeat
• bloody diarrhea
• sudden or severe stomach pain
• paleness or blue color of the fingers and toes
• shortness of breath
• swelling of the eyes, face, lips, tongue, or throat
• difficulty breathing or swallowing
• hoarseness
• rash
• hives
• pain, burning, or tingling in the hands or feet

Symptoms of zolmitriptan overdose may include:

• extreme drowsiness