Ascotop

zolmitriptan /zol·mi·trip·tan/ (zōl″mĭ-trip´tan) a selective serotonin receptor agonist used to relieve acute migraine.

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A serotonin receptor agonist used to treat migraine headaches.

zolmitriptan,

a migraine agent.

indications This drug is used in the acute treatment of migraine with or without aura.

contraindications Factors that prohibit the use of this drug include angina pectoris, a history of myocardial infarction, documented silent ischemia, ischemic heart disease, concurrent use of ergotamine-containing preparations, uncontrolled hypertension, known hypersensitivity to this drug, and basilar or hemiplegic migraine.

adverse effects Adverse effects of this drug include palpitations, abdominal discomfort, myalgia, and chest tightness and pressure. Common side effects include weakness, neck stiffness, tingling, hot sensation, burning, a feeling of pressure and tightness in the head, numbness, dizziness, and sedation.

zolmitriptan [zōl″mĭ-trip´tan]

a selective serotonin receptor agonist used to relieve acute migraine, administered orally.

zolmitriptan

Zomig, Zomig-ZMT

Pharmacologic class: Selective 5-hydroxytryptamine receptor agonist

Therapeutic class: Antimigraine agent

Pregnancy risk category C

Action

Blocks serotonin release, constricting inflamed and dilated cerebral and cranial blood vessels and reducing nerve transmission in trigeminal pain pathways

Availability

Nasal spray: 5-mg single-use spray device

Tablets (immediate-release): 2.5 mg, 5 mg

Tablets (orally disintegrating): 2.5 mg

⊘Indications and dosages

➣ Acute migraine

Adults: 1.25 to 2.5 mg (immediate-release) P.O., repeated if migraine returns in 2 hours or less; maximum dosage is 10 mg in any 24-hour period. Or 2.5 mg (orally disintegrating tablet) P.O., repeated if migraine returns in 2 hours or less; maximum dosage is 10 mg in any 24-hour period. Alternatively, one dose of nasal spray (5 mg); if migraine returns, may repeat dose after 2 hours; don't exceed maximum daily dosage of 10 mg in any 24-hour period.

Dosage adjustment

• Hepatic impairment

Contraindications

• Hypersensitivity to drug
• Hemiplegic or basilar migraine
• Ischemic cardiac disease or other significant cardiac disease
• Uncontrolled hypertension
• Cerebrovascular accident or transient ischemic attack
• Peripheral vascular disease, including ischemic bowel disease
• Use of ergot-type or ergot-containing drugs or other 5-HT₁ agonists within past 24 hours
• MAO inhibitor use within past 14 days

Precautions

Use cautiously in:
• hepatic or renal impairment
• risk factors for coronary artery disease (such as strong family history of this disease, diabetes mellitus, obesity, cigarette smoking, high cholesterol level, men older than age 40, postmenopausal women)
• elderly patients
• pregnant or breastfeeding patients
• children.

Administration

• Place orally disintegrating tablet on patient's tongue, where it should dissolve.
• Don't break orally disintegrating tablet in half.
• Know that each nasal spray unit is intended for one use only.

Route	Onset	Peak	Duration
P.O.	Unknown	2 hr	Unknown
Nasal	15 min	2-5 hr	24 hr

Adverse reactions

CNS: paresthesia, asthenia, dizziness, insomnia, hyperesthesia, drowsiness, syncope, vertigo, agitation, depression, anxiety, emotional lability, fatigue, malaise

CV: chest pain, heaviness, or tightness; hypertension; palpitations; angina; arrhythmias

EENT: dry eyes, ear pain, tinnitus, epistaxis, altered sense of smell, laryngitis

GI: nausea, vomiting, dyspepsia, dysphagia, gastroenteritis, esophagitis, dry mouth

GU: urinary frequency, hematuria, polyuria, cystitis

Hepatic: hepatic dysfunction

Metabolic: hyperglycemia

Musculoskeletal: leg cramps, neck pain, tenosynovitis, myasthenia, myalgia, back pain

Respiratory: bronchitis, hiccups

Skin: pruritus, rash, diaphoresis, bruising, urticaria, photosensitivity

Other: unusual taste, flushing, sweating or redness in face (with nasal spray); fever; chills; excessive thirst; facial or tongue edema; pressure or tightness in throat or jaw; yawning; warm or cold sensation

Interactions

Drug-drug. Cimetidine: doubling of zolmitriptan's half-life

Ergot-containing drugs: vasospasm

Fluoxetine, fluvoxamine, paroxetine, sertraline: weakness, incoordination, hyperreflexia

MAO inhibitors: increased zolmitriptan effects

Drug-diagnostic tests. Blood glucose: increased level

Drug-herbs. S-adenosylmethionine (SAM-e), St. John's wort: serotonin syndrome

Drug-behaviors. Smoking: increased risk of adverse cardiovascular effects

Patient monitoring

• Assess therapeutic response to help gauge drug efficacy.
• Watch for adverse cardiovascular and respiratory reactions, particularly dyspnea and chest pain or tightness.
• Assess blood glucose level in diabetic patient.

Patient teaching

☞ Tell patient to immediately report shortness of breath or pain or tightness in chest or throat.
• Explain that drug is intended to treat migraine, not prevent it.
• Tell patient to remove orally disintegrating tablet from blister pack just before taking it, and then place it on his tongue and let it dissolve. Instruct him not to break it.
• Teach patient proper use of nasal spray. Tell him each unit is intended for one use only.
• Caution patient to avoid driving and other hazardous activities during severe migraine or if drug causes adverse CNS effects.
• Inform patient that smoking may increase drug's cardiovascular risks.
• Advise female of childbearing age not to take drug if she is, might be, or plans to become pregnant.
• Advise patient to avoid sun exposure and to wear sunscreen and protective clothing when going outdoors.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.