Adult Dosing
Acute migraine attacks with or without aura
- 1.25-2.5 mg PO; if headache recurs may repeat dose at least 2 hours after first dose
- Alt: 2.5-5 mg ODT; if headache returns may repeat dose at least 2 hours after first dose
- Max: 10 mg/24 hours
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
- Zolmitriptan should be given only if a clear diagnosis of migraine has been established
- If the patient does not respond to the first dose, reconsider diagnosis of migraine headache before administration of a second dose
- Zolmitriptan is not indicated for prophylaxis of migraine or for use in the management of hemiplegic or basilar migraine
- Safety and effectiveness have not been established for cluster headache
- Zolmitriptan is contraindicated in patients with documented ischemic or vasospastic coronary artery disease
- Zolmitriptan should not be given when risk factors for CAD are present. Unrecognized coronary artery disease (CAD) is predicted by the presence of risk factors e.g., hypertension, hypercholesterolemia, smoking, obesity, diabetes, strong family history of CAD, female with surgical or physiological menopause, or male over 40 years of age. Do not use unless a cardiovascular evaluation establishes that the patient does not have CAD
- This drug is contraindicated in patients with uncontrolled hypertension
- Coronary artery vasospasm may occur; evaluate patients experiencing signs or symptoms suggestive of angina for the presence of CAD or a predisposition to Prinzmetal’s variant angina before administering additional doses and monitor electrocardiographically if dosing is resumed and similar symptoms recur. Patients experiencing other symptoms or signs suggestive of decreased arterial flow, such as ischemic bowel syndrome or Raynaud’s syndrome should be further evaluated
- It may cause coronary vasospasm in patients with history of coronary artery disease (CAD)
- Avoid zolmitriptan administration if cardiovascular evaluation, patient’s medical history, electrocardiographic or other investigations reveal findings suggestive of coronary artery vasospasm or myocardial ischemia.
- For patients with risk factors suggestive of CAD but having satisfactory CV reports on evaluation administer first dose of zolmitriptan in the presence of a physician or similar medically staff in well equipped facility unless the patient has previously received this drug
- Consider obtaining an ECG on the first occasion of use of zolmitriptan during the interval immediately following its use in patients with risk factors as cardiac ischemia may occur in the absence of clinical symptoms
- Intermittent long term users and those having or acquired with risk factors suggestive of CAD should undergo periodic cardiovascular evaluation
- Serious adverse cardiac events, including acute MI, have been reported within a few hours following administration
- Postmarketing data reveals that serious CV events have occurred in association with the use of this drug and in rare cases these events have occurred in the absence of known cardiovascular disease
- Cerebral hemorrhage, subarachnoid hemorrhage, stroke, and other cerebrovascular events have occurred with 5-HT1 agonists
- Blindness and significant partial vision loss have been reported, rarely
- Avoid this drug in patients with symptomatic Wolff-Parkinson-White syndrome or arrhythmias associated with other cardiac accessory conduction pathway disorders
- Potential for development of a life-threatening serotonin syndrome exists if this drug is used concurrently with selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs). If concomitant treatment is essential carefully observe patients particularly during treatment initiation and dose increments
- 5-HT1 agonists are associated with vasospastic reactions other than coronary artery vasospasm such as peripheral and gastrointestinal vascular ischemia. Rare occasions of gastrointestinal ischemic events including ischemic colitis and gastrointestinal infarction or necrosis may occur
- Overuse of migraine drugs may lead to worsening of headache, or increase in frequency of migraine attacks. Consider detoxification process, including withdrawal of the overused drugs, and treatment for withdrawal symptoms in patients who overuse migraine drugs
- Zolmitriptan may induce toxicity in melanin rich tissues after extended use
- Intermittent long term users should undergo periodic cardiovascular evaluation
- Monitor BP at baseline, cardiovascular evaluation at baseline, then periodically during long-term treatment if risk factors present
Cautions: Use cautiously in
- Diabetes mellitus
- Hypertension (due to possibility of unrecognized CAD)
- Hepatic impairment (dose reduction recommended; use alternate dosage form)
- Presence of cardiac risk factors
- Geriatric population (due to presence of risk factors for hypertension, hypercholesterolemia, possibility of unrecognized CAD)
- Phenylketonuria with orally disintegrating tablets that contain phenylalanine
Pregnancy Category:C
Breastfeeding: Safety Unknown. An alternate drug may be preferred, especially while nursing a newborn or preterm infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 25 August 2011). Manufacturer advises caution.
Pricing data from www.DrugStore.com in U.S.A.
- Zomig 5 MG TABS [Box] (ASTRAZENECA)
3 mg = $91.99
9 mg = $259.96 - Zomig 2.5 MG TABS [Box] (ASTRAZENECA)
6 mg = $167
18 mg = $470.95
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
