Zolmitriptan (Zolmitriptan) for Migraine Relief

Zomig (zolmitriptan) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of migraines in adults. The tablet is available in a form that can be swallowed, as well as an oral (by mouth) disintegrating form.

Zomig ZMT (zolmitriptan nasal spray) is FDA approved for the treatment of migraines in adults and children age 12 and older.

Zolmitriptan is one of the triptan medications, a category of prescription migraine treatments used to alleviate acute migraine attacks.

How It Works

Zolmitriptan works by the same mechanism of the other triptans. It interacts with the blood vessels in the brain and it inhibits pain.

According to the manufacturer, zolmitriptan preferentially binds to serotonin 5­ HT1D and 5 HT1B receptors. This causes vasoconstriction (narrowing of the blood vessels) in the brain. Migraines are associated with vasodilation (widening of the blood vessels), so alleviating this effect is believed to play a role in reducing the symptoms of an acute migraine attack.

Zolmitriptan may also reduce inflammation and stimulation of the sensory nerves, particularly the trigeminal nerve, which mediates migraine pain.

Forms and Dosing

Because this medication is available as a tablet, an orally disintegrating tablet, and a nasal spray, you have several options to think about when considering your preferred route of administration. The orally disintegrating tablet and the nasal spray may be easier for you than the tablet if you experience nausea with your migraines or if you have trouble swallowing.

Like other triptans, zolmitriptan is a powerful medication. Be sure to use it as recommended and not to exceed the maximum recommended daily dose.

Tablet

Zolmitriptan tablets are available in 2.5 mg or 5 mg strengths. The 2.5 mg tablets are scored so they can be cut in half, which allows you to take 1.25 mg. (You might be given instructions to take 1.25 mg, 2.5 mg, or 5 mg for an acute migraine episode.)

If a migraine does not resolve or if it returns after improvement, a second dose of zolmitriptan may be repeated two hours after the first dose.

The maximum daily dose of zolmitriptan is 10 mg within a 24-hour period.

Exception: If you have moderate to severe liver impairment, it is recommended that you only take a 1.25 mg dose of zolmitriptan. Your maximum daily dose should be 5 mg of zolmitriptan, as opposed to 10 mg.

Disintegrating Tablet

Orally disintegrating tablets are available in 2.5 mg and 5 mg strengths. These tablets dissolve on your tongue and cannot be cut, therefore it cannot be taken as a 1.25 mg dose. The recommended dose is the same as that of the regular tablet otherwise.

Nasal Spray

The zolmitriptan nasal spray comes in a 2.5 mg strength and a 5 mg strength. It is taken as a single spray of 2.5 mg or 5 mg in one nostril. If the migraine persists or returns within two hours of the first dose, a second dose may be repeated once.

The maximum daily dose should not exceed 10 mg.

A pediatrician will recommend the right dose of zolmitriptan nasal spray for your child based on his or her size and weight, medical history, and other medications.

Skin Adhesive in Development

Another form, the Adhesive Dermally-Applied Microarray (ADAM) zolmitriptan, is currently being developed and was recently accepted by FDA.

Side Effects

Zomig can produce the same side effects as other triptans. Common side effects typically last for approximately an hour and include:

• Sleepiness
• Warm or cold sensation
• Tingling
• Nausea

The zolmitriptan spray may cause an unpleasant taste in your mouth.

Complications

Zolmitriptan and other triptans have been linked to several serious conditions, such as a heart attack, potentially life-threatening heart arrhythmias (irregular heartbeat), and increased blood pressure.

Interactions

Zolmitriptan interacts with the Tagamet (cimetidine), a medication used for heartburn. If you are taking both medications, your doctor or pharmacist will recommend a maximum single dose of zolmitriptan of 2.5mg and a maximum daily dose of 5 mg.

It is not safe to use zolmitriptan within 24 hours of another triptan or ergotamine medication.

When zolmitriptan is used along with antidepressants, including serotonin reuptake inhibitors and monoamine oxidase-A inhibitors, it can increase the risk of serotonin syndrome, a rare but serious condition.

Contraindications

Zolmitriptan is not safe for you if you have any of the following conditions:

• A history of coronary artery disease, including stable angina or a heart attack
• Prinzmetal angina (when the blood vessels that supply the heart spasm)
• Wolff-Parkinson-White Syndrome
• History of stroke or "mini-stroke," called a transient ischemic attack (TIA)
• History of hemiplegic migraine or migraine with brainstem aura
• Peripheral vascular disease
• Ischemic bowel disease
• Uncontrolled high blood pressure
• Known allergy to zolmitriptan

Experts suggest caution in taking a triptan if you have risk factors for coronary heart disease, like obesity, a history of smoking or diabetes, or a family history of heart disease.

Disintegrating Tablet Precaution

The zolmitriptan oral disintegrating tablets (Zomig ZMT) contain a substance called phenylalanine, a component of aspartame. Ingesting phenylalanine can be harmful if you have phenylketonuria. Take note, the regular zolmitriptan tablets (Zomig) do not contain phenylalanine.

A Word From Verywell

There are a number of powerful prescription migraine medications, and zolmitriptan and other triptans are considered very effective and safe if you don't have contraindications. Still, it is a good idea to try over-the-counter remedies first before using stronger medications such as triptans.

Be sure to keep track of how many times you are using zolmitriptan. If you are taking more than four doses per month, talk to your doctor about strategies to prevent your migraines and possibly revisiting your treatment plan.