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Pharmacologic class: Selective 5-hydroxytryptamine receptor agonist
Therapeutic class: Antimigraine agent
Pregnancy risk category C
Blocks serotonin release, constricting inflamed and dilated cerebral and cranial blood vessels and reducing nerve transmission in trigeminal pain pathways
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.
• Hepatic impairment
• 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
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
• 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.
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
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
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
• 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.
☞ 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.