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zolmitriptan (Rx)Brand and Other Names:Zomig, Zomig Rapimelt, more...Zomig-ZMT

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 2.5mg (scored)
  • 5mg

oral disintegrating tablet

  • 2.5mg
  • 5mg

intranasal spray

  • 2.5mg/single-use device
  • 5mg/single-use device
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Migraine

Indicated for acute treatment of migraine with or without aura

Initial dose: 2.5 mg PO/intranasally at onset of migraine

Individual response varies, may increase dose to 5 mg; do not exceed 5 mg per single dose

If migraine has not resolved, may repeat dose after 2 hr if needed; not to exceed 10 mg/24 hr

Safety not established in the treatment of an average of >3 migraines/30 days (tablets) or >4 migraines/30 days (intranasal)

Dosage Modifications

Coadministration with cimetidine: Limit zolmitriptan to 2.5 mg/dose and 5 mg/day

Renal impairment: Not evaluated with nasal spray; with oral dosing, zolmitriptan clearance reduced by 25% in patients with severe renal clearance

Hepatic impairment

  • Mild: No dosage adjustment required
  • Moderate-to-severe: Not recommended; increased zolmitriptan blood levels may elevate blood pressure in some patients

Dosage Forms & Strengths

Intranasal spray

  • 2.5mg/single-use device
  • 5mg/single-use device

Migraine

Nasal spray dosage form indicated for acute treatment of migraine with or without aura in pediatric patients aged ≥12 yr

<12 years: Safety and efficacy not established

Initial dose: 2.5 mg intranasally at onset of migraine

Individual response varies, may increase dose to 5 mg; do not exceed 5 mg per single dose

If migraine has not resolved, may repeat dose after 2 hr if needed; not to exceed 10 mg/24 hr

Safety not established in the treatment of an average of >4 migraines/30 days

Dosage Modifications

Coadministration with cimetidine: Limit zolmitriptan to 2.5 mg/dose and 5 mg/day

Renal impairment: Not evaluated with nasal spray; with oral dosing, zolmitriptan clearance reduced by 25% in patients with severe renal clearance

Hepatic impairment

  • Mild: No dosage adjustment required
  • Moderate-to-severe: Not recommended; increased zolmitriptan blood levels may elevate blood pressure in some patients
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Interactions

Interaction Checker

zolmitriptan and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            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%)

            <1%

            QT prolongation

            Bradycardia

            Tachycardia

            Thrombophlebitis

            Postural hypotension

            Hyperglycemia

            Alk phos increased

            Arthritis

            Twitching

            Myocardial infarction and artery vasospasm in patients with CAD risk factors

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            Warnings

            Contraindications

            Hypersensitivity

            Ischemic or vasospastic artery disease

            Uncontrolled HTN

            Wolf-Parkinson-White syndrome

            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

            Do not use within 24 hr of other 5-HT agonist or ergotamine-containing or ergot-type medication

            Cautions

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

            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

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

            Significant increases in blood pressure reported

            Serotonin syndrome: 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)

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: unknown, use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Selective 5-HT1 receptor agonist in cranial arteries. Causes vasoconstriction and reduces inflammation associated with antidronic neuronal transmission associated with relief of migraine

            Pharmacokinetics

            Half-Life elimination: 2.8-3.7 hr

            Peak Plasma Time: 1.5 hr; 3 hr (ZMT)

            Bioavailability: 40%

            Onset of action: 0.5-1 hr

            Protein Bound: 25%

            Vd: 7.0 L/kg

            Metabolism: liver

            Metabolites: N-desmethyl zolmitriptan

            Excretion: Urine (65%); Feces (30%)

            Clearance

            • Total Body: 31.5 mL/min/kg
            • Renal: 5.25 mL/min/kg
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            Administration

            Instructions

            For 1.25 mg dose, manually break the scored 2.5 mg regular oral tablet in half

            Do not break orally disintegrating tablets

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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