Zomig (Zolmitriptan Nasal)

Generic name:

Zolmitriptan

Drug class:

Selective 5-HT_1B/1D receptor agonist (triptan)

Dosage form:

Nasal spray (2.5 mg/0.1 mL, 5 mg/0.1 mL)

Root of administration:

Intranasal

Dose:

Adults: 5 mg as a single dose. If headache recurs, a second 5 mg dose may be administered ≥2 hours after the first dose. Maximum 10 mg/24 hours. Some patients may respond to an initial 2.5 mg dose; maximum 5 mg/24 hours. Pediatric: not indicated.

Mechanism of action:

Zolmitriptan is a selective agonist of serotonin 5-HT_1B and 5-HT_1D receptors, causing cranial vessel vasoconstriction and inhibiting release of pro-inflammatory neuropeptides (e.g., CGRP), thereby relieving migraine pain.

Drug usage cases:

• Acute treatment of migraine attacks with or without aura in adults
• Off-label: medication-overuse headache prevention (varies by practice)

Drug contra indications:

• Ischemic heart disease (including angina, myocardial infarction, coronary artery vasospasm)
• Cerebrovascular syndromes (e.g., stroke, transient ischemic attack)
• Peripheral vascular disease
• Uncontrolled hypertension
• Hemiplegic or basilar migraine
• Hypersensitivity to zolmitriptan or formulation excipients
• Concurrent or recent (< 24 hours) administration of ergotamine, dihydroergotamine
• Use of monoamine oxidase A inhibitors within 14 days
• Severe hepatic impairment

Side effects:

• Common: abnormal taste, nasal discomfort, nausea, dizziness, somnolence, paresthesia, fatigue, throat irritation
• Cardiovascular: chest pain, chest tightness, palpitations, hypertension
• CNS: headache recurrence, vertigo, tremor
• Respiratory: nasal mucosal ulceration, epistaxis
• Gastrointestinal: dyspepsia
• Serious: serotonin syndrome (especially with SSRIs/SNRIs/MAOIs), ischemic events (myocardial ischemia, cerebrovascular syndromes)

Warnings:

• Cardiovascular risk: evaluate for cardiovascular disease before prescribing; monitor blood pressure
• Medication-overuse headache: risk with frequent use (> 10 days/month)
• CNS effects: monitor for serotonin syndrome
• Hypersensitivity: anaphylaxis or angioedema may occur
• Hepatic impairment: adjust dose; avoid in severe impairment
• Renal impairment: use caution; adjust dose in severe impairment
• Local nasal effects: burning, dryness, mucosal ulceration
• Elderly: safety not established

Use during pregnancy or breastfeeding:

Pregnancy: Category C. Animal studies have shown fetal harm at high doses; no adequate human studies. Use only if potential benefit justifies potential risk. Breastfeeding: Zolmitriptan is excreted in human milk; effects on the breastfed infant are unknown. Consider discontinuing breastfeeding or the drug, weighing maternal benefit against potential infant risk.