Dosing & Uses
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
Migraine
Indicated for acute treatment of migraine with or without aura
2.5 mg PO/intranasally, initially, at onset of migraine
Dosing considerations
- May increase dose to 5 mg; not to exceed 5 mg per single dose; individual response varies
- May repeat dose if migraine has not resolved after 2 hr; not to exceed 10 mg/24 hr
- Safety not established for tablets in the treatment of >3 migraines/30 days or >4 migraines/30 days for the intranasal formulation
Dosage Modifications
Coadministration with cimetidine: Limit zolmitriptan to 2.5 mg/dose and 5 mg/day
Renal impairment
- No dosage adjustment provided by manufacturer labeling; clearance is reduced in patients with severe renal impairment (CrCl 5-25 mL/min)
Hepatic impairment
Tablet
- Mild: No dosage adjustment provided by manufacturer labeling
- Moderate to severe: 1.25 mg; not to exceed 5 mg/day in severe impairment
Disintegrating tablet, oral
- Mild: No dosage adjustment provided by manufacturer labeling
- Moderate to severe: Not recommended
Nasal inhalation
- Mild: No dosage adjustment provided by manufacturer labeling
- Moderate to severe: Not recommended
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
≥12 years
- 2.5 mg PO/intranasally, initially, at onset of migraine
Dosing considerations
- May increase dose to 5 mg; not to exceed 5 mg per single dose; individual response varies
- May repeat dose if migraine has not resolved after 2 hr; not to exceed 10 mg/24 hr
- Safety not established for tablets in the treatment of >3 migraines/30 days or >4 migraines/30 days for the intranasal formulation
Dosage Modifications
Coadministration with cimetidine: Limit zolmitriptan to 2.5 mg/dose and 5 mg/day
Renal impairment
- No dosage adjustment provided by manufacturer labeling; clearance is reduced in patients with severe renal impairment (CrCl 5-25 mL/min)
Hepatic impairment
Tablet
- Mild: No dosage adjustment provided by manufacturer labeling
- Moderate to severe: 1.25 mg; not to exceed 5 mg/day in severe impairment
Disintegrating tablet, oral
- Mild: No dosage adjustment provided by manufacturer labeling
- Moderate to severe: Not recommended
Nasal inhalation
- Mild: No dosage adjustment provided by manufacturer labeling
- Moderate to severe: Not recommended
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (15)
- almotriptan
almotriptan, zolmitriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- bromocriptine
bromocriptine, zolmitriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Vasoconstrictive effects of triptans and bromocriptine may be additive. Drugs should not be used within 24h of one another.
- cabergoline
cabergoline, zolmitriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- dihydroergotamine
dihydroergotamine, zolmitriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- dihydroergotamine intranasal
dihydroergotamine intranasal, zolmitriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- eletriptan
eletriptan, zolmitriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- ergoloid mesylates
ergoloid mesylates, zolmitriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- ergotamine
ergotamine, zolmitriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- frovatriptan
frovatriptan, zolmitriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- methylergonovine
methylergonovine, zolmitriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- naratriptan
naratriptan, zolmitriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- procarbazine
zolmitriptan and procarbazine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.
procarbazine increases levels of zolmitriptan by serotonin levels. Contraindicated. Concurrent use or use within 2 weeks of MAOI therapy is contraindicated. If procarbazine is required, naratriptan, eletriptan or frovatriptan may be a suitable 5-HT1D agonist to employ. Monitor for signs and symptoms of serotonin toxicity/serotonin syndrome during such therapy. - rizatriptan
rizatriptan, zolmitriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- sumatriptan
sumatriptan, zolmitriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- sumatriptan intranasal
sumatriptan intranasal, zolmitriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
Serious - Use Alternative (19)
- citalopram
citalopram, zolmitriptan. Mechanism: unknown. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome. If concomitant treatment with citalopram and a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.
- cyclobenzaprine
zolmitriptan and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.
- desvenlafaxine
zolmitriptan and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.
- dolasetron
dolasetron, zolmitriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- granisetron
granisetron, zolmitriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- isocarboxazid
zolmitriptan and isocarboxazid both increase serotonin levels. Avoid or Use Alternate Drug.
isocarboxazid increases levels of zolmitriptan by decreasing metabolism. Contraindicated. - linezolid
zolmitriptan and linezolid both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.
linezolid increases levels of zolmitriptan by decreasing metabolism. Contraindicated. - lorcaserin
zolmitriptan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.
- methylene blue
zolmitriptan and methylene blue both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.
- netupitant/palonosetron
netupitant/palonosetron, zolmitriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- ondansetron
ondansetron, zolmitriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- ozanimod
ozanimod increases toxicity of zolmitriptan by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
- palonosetron
palonosetron, zolmitriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- phenelzine
zolmitriptan and phenelzine both increase serotonin levels. Avoid or Use Alternate Drug.
phenelzine increases levels of zolmitriptan by decreasing metabolism. Contraindicated. - rasagiline
zolmitriptan and rasagiline both increase serotonin levels. Avoid or Use Alternate Drug. Avoid combination within 14 days of MAOI use
- tedizolid
tedizolid, zolmitriptan. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.
- tranylcypromine
zolmitriptan and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug.
tranylcypromine increases levels of zolmitriptan by decreasing metabolism. Contraindicated. - vilazodone
zolmitriptan, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .
- vortioxetine
zolmitriptan, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.
Monitor Closely (86)
- 5-HTP
zolmitriptan and 5-HTP both increase serotonin levels. Use Caution/Monitor.
- almotriptan
almotriptan and zolmitriptan both increase serotonin levels. Use Caution/Monitor.
- amitriptyline
zolmitriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- amoxapine
zolmitriptan and amoxapine both increase serotonin levels. Modify Therapy/Monitor Closely.
- aripiprazole
zolmitriptan, aripiprazole. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- asenapine
zolmitriptan, asenapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, zolmitriptan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- buspirone
zolmitriptan and buspirone both increase serotonin levels. Modify Therapy/Monitor Closely.
- cariprazine
zolmitriptan, cariprazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- cimetidine
cimetidine increases levels of zolmitriptan by unknown mechanism. Modify Therapy/Monitor Closely. Half-life and blood levels of zolmitriptan and its active N-desmethyl metabolite are approximately doubled when coadministered with cimetidine; limit zolmitriptan to 2.5 mg/dose and 5 mg/day.
- clomipramine
zolmitriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- clozapine
zolmitriptan, clozapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- cocaine topical
zolmitriptan and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.
- cyproheptadine
cyproheptadine decreases effects of zolmitriptan by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of serotonin agonists.
- deferasirox
deferasirox will increase the level or effect of zolmitriptan by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Avoid concomitant use, but if necessary consider decreasing zolmitriptan dose.
- desipramine
zolmitriptan and desipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- dexfenfluramine
zolmitriptan and dexfenfluramine both increase serotonin levels. Use Caution/Monitor.
- dextroamphetamine
zolmitriptan and dextroamphetamine both increase serotonin levels. Use Caution/Monitor.
- dextroamphetamine transdermal
zolmitriptan, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).
- dextromethorphan
zolmitriptan and dextromethorphan both increase serotonin levels. Modify Therapy/Monitor Closely.
- dihydroergotamine
zolmitriptan and dihydroergotamine both increase serotonin levels. Use Caution/Monitor.
- dihydroergotamine intranasal
zolmitriptan and dihydroergotamine intranasal both increase serotonin levels. Use Caution/Monitor.
- dosulepin
zolmitriptan and dosulepin both increase serotonin levels. Modify Therapy/Monitor Closely.
- doxepin
zolmitriptan and doxepin both increase serotonin levels. Modify Therapy/Monitor Closely.
- droxidopa
zolmitriptan and droxidopa both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. May increase risk for supine hypertension
- duloxetine
zolmitriptan and duloxetine both increase serotonin levels. Modify Therapy/Monitor Closely.
- eletriptan
eletriptan and zolmitriptan both increase serotonin levels. Use Caution/Monitor.
- ergotamine
zolmitriptan and ergotamine both increase serotonin levels. Use Caution/Monitor.
- escitalopram
zolmitriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.
- fenfluramine
zolmitriptan and fenfluramine both increase serotonin levels. Use Caution/Monitor.
fenfluramine, zolmitriptan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome. - fluoxetine
zolmitriptan and fluoxetine both increase serotonin levels. Modify Therapy/Monitor Closely.
- fluphenazine
zolmitriptan, fluphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- fluvoxamine
fluvoxamine and zolmitriptan both increase serotonin levels. Modify Therapy/Monitor Closely.
- frovatriptan
frovatriptan and zolmitriptan both increase serotonin levels. Use Caution/Monitor.
- haloperidol
zolmitriptan, haloperidol. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- hydrocodone
hydrocodone, zolmitriptan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- iloperidone
zolmitriptan, iloperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- imipramine
zolmitriptan and imipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- isoniazid
zolmitriptan and isoniazid both increase serotonin levels. Use Caution/Monitor.
- L-tryptophan
zolmitriptan and L-tryptophan both increase serotonin levels. Use Caution/Monitor.
- levomilnacipran
zolmitriptan and levomilnacipran both increase serotonin levels. Modify Therapy/Monitor Closely.
- lisdexamfetamine
zolmitriptan and lisdexamfetamine both increase serotonin levels. Use Caution/Monitor.
- lithium
zolmitriptan and lithium both increase serotonin levels. Use Caution/Monitor.
- lofepramine
zolmitriptan and lofepramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- loxapine
zolmitriptan, loxapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- loxapine inhaled
zolmitriptan, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- lsd
zolmitriptan and lsd both increase serotonin levels. Use Caution/Monitor.
- lurasidone
zolmitriptan, lurasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- maprotiline
zolmitriptan and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.
- meperidine
zolmitriptan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.
- milnacipran
zolmitriptan and milnacipran both increase serotonin levels. Modify Therapy/Monitor Closely.
- mirtazapine
zolmitriptan and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- molindone
zolmitriptan, molindone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- morphine
zolmitriptan and morphine both increase serotonin levels. Use Caution/Monitor.
- naratriptan
naratriptan and zolmitriptan both increase serotonin levels. Use Caution/Monitor.
- nefazodone
zolmitriptan and nefazodone both increase serotonin levels. Modify Therapy/Monitor Closely.
- nortriptyline
zolmitriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- olanzapine
zolmitriptan, olanzapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- oliceridine
zolmitriptan, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.
- paliperidone
zolmitriptan, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- paroxetine
zolmitriptan and paroxetine both increase serotonin levels. Modify Therapy/Monitor Closely.
- pentazocine
zolmitriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.
- perphenazine
zolmitriptan, perphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- pimavanserin
zolmitriptan, pimavanserin. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- pimozide
zolmitriptan, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- protriptyline
zolmitriptan and protriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- quetiapine
zolmitriptan, quetiapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- remifentanil
remifentanil increases toxicity of zolmitriptan by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.
- risperidone
zolmitriptan, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- rizatriptan
rizatriptan and zolmitriptan both increase serotonin levels. Use Caution/Monitor.
- SAMe
zolmitriptan and SAMe both increase serotonin levels. Use Caution/Monitor.
- selegiline
zolmitriptan and selegiline both increase serotonin levels. Modify Therapy/Monitor Closely.
- selegiline transdermal
zolmitriptan and selegiline transdermal both increase serotonin levels. Modify Therapy/Monitor Closely.
- sertraline
zolmitriptan and sertraline both increase serotonin levels. Modify Therapy/Monitor Closely.
- St John's Wort
zolmitriptan and St John's Wort both increase serotonin levels. Modify Therapy/Monitor Closely.
- sufentanil SL
sufentanil SL, zolmitriptan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- sumatriptan
sumatriptan and zolmitriptan both increase serotonin levels. Use Caution/Monitor.
- sumatriptan intranasal
sumatriptan intranasal and zolmitriptan both increase serotonin levels. Use Caution/Monitor.
- tapentadol
zolmitriptan and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.
- thiothixene
zolmitriptan, thiothixene. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- tramadol
zolmitriptan and tramadol both increase serotonin levels. Use Caution/Monitor.
- trazodone
zolmitriptan and trazodone both increase serotonin levels. Modify Therapy/Monitor Closely.
- trifluoperazine
zolmitriptan, trifluoperazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- trimipramine
zolmitriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- venlafaxine
zolmitriptan and venlafaxine both increase serotonin levels. Modify Therapy/Monitor Closely.
- ziprasidone
zolmitriptan, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
Minor (9)
- duloxetine
duloxetine, zolmitriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- escitalopram
escitalopram, zolmitriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- fluoxetine
fluoxetine, zolmitriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- milnacipran
milnacipran, zolmitriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- nefazodone
nefazodone, zolmitriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- paroxetine
paroxetine, zolmitriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- sertraline
sertraline, zolmitriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- trazodone
trazodone, zolmitriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- venlafaxine
venlafaxine, zolmitriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
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
Warnings
Contraindications
Hypersensitivity
History of myocardial infarction
Ischemic or vasospastic artery disease, including Prinzmetal variant angina or other significant underlying cardiovascular disease
Uncontrolled HTN
Wolff-Parkinson-White syndrome or arrhythmias associated with other cardiac accessory conduction pathway disorders
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
Recent use (ie, within 24 hr) of another 5-HT1 agonist, ergotamine-containing medication, or ergot-type medication (such as dihydroergotamine or methysergide)
History of stroke
Transient ischemic attack, or history of hemiplegic or basilar migraine
Cautions
Little added benefit with 5 mg PO dose compared with 2.5 mg
Coronary artery vasospasm, myocardial infarction, transient ischemia, ventricular tachycardia/fibrillation, cardiac arrest, and death reported with use
In patients who experience symptoms or signs suggestive of a vasospastic reaction following the use of any 5-HT1 agonist, rule out a vasospastic reaction before receiving additional doses
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
Before treating headaches in patients not previously diagnosed as migraineurs, and in migraineurs who present with symptoms atypical for migraine, exclude other potentially serious neurological conditions; drug is contraindicated in patients with a history of stroke or transient ischemic attack
May cause noncoronary vasospastic reactions (eg, peripheral vascular ischemia, GI vascular ischemia and infarction, splenic infarction, and Raynaud’s syndrome
Significant elevation in blood pressure, including hypertensive crisis reported in patients with and without history of hypertension; monitor blood pressure in patients receiving therapy
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); discontinue therapy if serotonin syndrome suspected
Partial vision loss and blindness (transient and permanent) reported with 5-HT1 agonists
Use caution in elderly patients, who are more likely to have underlying cardiovascular disease and hepatic or renal impairment; cardiovascular evaluation recommended in patients with other cardiovascular risk factors prior to initiation of therapy
Therapy is indicated for acute treatment of migraine headache; not for migraine prophylaxis
Use for 10 or more days per month may lead to worsening of headaches; detoxification of patients, including withdrawal of overused drugs, and treatment of withdrawal symptoms (which often includes a transient worsening of headache) may be necessary
Phenylalanine can be harmful to patients with phenylketonuria (PKU). orally disintegrating tablets contain phenylalanine (a component of aspartame); each 2.5 mg and 5 mg orally disintegrating tablet contains 2.81 and 5.62 mg of phenylalanine, respectively; tablets do not contain phenylalanine
Coronary artery disease
- Not for administration to patients with risk factors for coronary artery disease (CAD), including hypercholesterolemia, obesity, smoker, diabetes, menopause, male >40 years, or strong family history of CAD
- Patients at risk should have CAD ruled out before initiating therapy
- First dose should be given in healthcare providers office if cardiovascular evaluation is satisfactory
- Cardiovascular status should be evaluated periodically in all patients receiving therapy
- For patients with multiple cardiovascular risk factors with negative cardiovascular evaluation, consider administering first dose in a medically-supervised setting and performing an electrocardiogram (ECG) immediately following administration; for such patients, consider periodic cardiovascular evaluation in intermittent long-term users of drug
Pregnancy & Lactation
Pregnancy
There are no adequate data on the developmental risk associated with the use in pregnant women; in reproductive toxicity studies in rats and rabbits, oral administration of zolmitriptan to pregnant animals resulted in embryolethality and fetal abnormalities (malformations and variations) at clinically relevant exposures
Published data have suggested that women with migraine may be at increased risk of preeclampsia during pregnancy
Lactation
There are no data on presence of drug or metabolites in human milk, effects on the breastfed infant, or on milk production; in rats, oral dosing with zolmitriptan resulted in levels in milk up to 4 times that in maternal plasma
Developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from drug or from underlying maternal condition
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.Pharmacology
Mechanism of Action
Selective 5-HT1 receptor agonist in cranial arteries; causes vasoconstriction and reduces inflammation associated with antidromic neuronal nerve fiber transmission
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
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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Zomig nasal - | 5 mg liquid |  | |
| Zomig nasal - | 2.5 mg liquid |  | |
| zolmitriptan oral - | 2.5 mg tablet |  | |
| zolmitriptan oral - | 2.5 mg tablet |  | |
| zolmitriptan oral - | 2.5 mg tablet |  | |
| zolmitriptan oral - | 5 mg tablet |  | |
| zolmitriptan oral - | 5 mg tablet |  | |
| zolmitriptan oral - | 2.5 mg tablet |  | |
| zolmitriptan oral - | 2.5 mg tablet |  | |
| zolmitriptan oral - | 2.5 mg tablet |  | |
| zolmitriptan oral - | 2.5 mg tablet |  | |
| zolmitriptan oral - | 5 mg tablet |  | |
| zolmitriptan oral - | 5 mg tablet |  | |
| zolmitriptan oral - | 2.5 mg tablet |  | |
| zolmitriptan oral - | 5 mg tablet |  | |
| zolmitriptan oral - | 2.5 mg tablet |  | |
| zolmitriptan oral - | 5 mg tablet |  | |
| zolmitriptan oral - | 5 mg tablet |  | |
| zolmitriptan oral - | 2.5 mg tablet |  | |
| zolmitriptan oral - | 5 mg tablet |  | |
| zolmitriptan oral - | 5 mg tablet |  | |
| zolmitriptan oral - | 5 mg tablet |  | |
| Zomig oral - | 2.5 mg tablet |  | |
| Zomig oral - | 5 mg tablet | | |
| Zomig oral - | 2.5 mg tablet | | |
| Zomig oral - | 5 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
zolmitriptan nasal
ZOLMITRIPTAN SPRAY - NASAL
(ZOLE-mi-TRIP-tan)
COMMON BRAND NAME(S): Zomig
USES: Zolmitriptan is used to treat migraines. It helps to relieve headache, pain, and other migraine symptoms (including nausea, vomiting, sensitivity to light/sound). Prompt treatment helps you return to your normal routine and may decrease your need for other pain medications. Zolmitriptan belongs to a class of drugs known as triptans. It affects a certain natural substance (serotonin) that causes narrowing of blood vessels in the brain. It may also relieve pain by affecting certain nerves in the brain.Zolmitriptan does not prevent future migraines or lessen how often you get migraine attacks.
HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start using zolmitriptan spray and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Use this medication at the first sign of a migraine as directed by your doctor, usually 1 spray into one nostril. Avoid spraying into your eyes. Blow your nose gently before using this medication. Remove the protective cap, and block one nostril by pressing firmly on either side of your nose. Place the tip of the spray device into the other nostril and breathe in gently as you press the plunger. Keep your head tilted slightly back, remove the tip from your nose, and breathe gently through your mouth for 5 to 10 seconds. Your nose may feel wet inside and you may notice a slight taste after using the spray. This is normal.If there is no improvement in your symptoms, do not take more doses of this medication before talking to your doctor. If your symptoms are only partly relieved, or if your headache comes back, you may use another dose at least two hours after the first dose. Do not use more than 10 milligrams in a 24-hour period.The dosage is based on your medical condition, response to treatment, and other medications you may be taking. Be sure to tell your doctor about all the products you use, including prescription drugs, nonprescription drugs, and herbal products.If you have a higher risk for heart problems (see Precautions), your doctor may perform a heart exam before you start taking zolmitriptan. He/she may also direct you to take your first dose of this medication in the office/clinic to monitor for serious side effects (such as chest pain). Talk to your doctor for details.If you are using drugs for migraine attacks on 10 or more days each month, the drugs may actually make your headaches worse (medication overuse headache). Do not use medications more often or for longer than directed. Tell your doctor if you need to use this medication more often, or if the medication is not working as well, or if your headaches get worse.
SIDE EFFECTS: Unusual taste, dry mouth, discomfort in the nose, tingling/numbness, nausea, weakness, drowsiness, or dizziness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.Tell your doctor right away if you have any serious side effects, including: blue fingers/toes/nails, cold hands/feet.Zolmitriptan can commonly cause chest/jaw/neck tightness, pain, or pressure that is usually not serious. However, these side effects are like symptoms of a heart attack, which may include chest/jaw/left arm pain, shortness of breath, or unusual sweating. Get medical help right away if these or other serious side effects occur, including: fast/irregular heartbeat, fainting, severe stomach/abdominal pain, bloody diarrhea, signs of a stroke (such as weakness on one side of the body, trouble speaking, sudden vision changes, confusion).This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using zolmitriptan, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood circulation problems (for example, in your legs, arms/hands, or stomach), certain types of headaches (hemiplegic or basilar migraine), heart problems (such as chest pain, irregular heartbeat, previous heart attack), liver disease, seizure, stroke or "mini-stroke" (transient ischemic attack).Certain conditions can increase your risk for heart problems. Tell your doctor if you have any of these conditions, including: high blood pressure, high cholesterol, diabetes, family history of heart disease, overweight, smoker, postmenopausal (women), age more than 40 years (men).This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).The risk of heart disease, liver disease, and high blood pressure increases with age. Older adults may be more sensitive to the side effects of this drug, especially increased blood pressure and heart problems.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Do not take any MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.If you also take any ergotamine medication (such as dihydroergotamine) or other "triptan" drugs (such as sumatriptan, rizatriptan), you will need to separate your zolmitriptan dose from your dose of these other medications to lessen the chance of serious side effects. Ask your doctor how long you should wait between your doses of these drugs.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: Do not share this medication with others.Certain foods, beverages, or food additives (such as red wine, cheese, chocolate, monosodium glutamate) as well as lifestyle patterns such as irregular eating/sleeping habits or stress may bring on a migraine headache. Avoiding these "triggers" may help lessen migraine attacks. Consult your doctor for more details.Lab and/or medical tests (such as blood pressure) may be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: Not applicable. (See How to Use section.)
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets. Each spray device contains one dose; discard after using.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised December 2022. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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- View the formulary and any restrictions for each plan.
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