Names and pronunciation
(zole-mih-trip′tan) Zomig, Zomig-ZMT
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Drug reference
(zole-mih-trip′tan) Zomig, Zomig-ZMT
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Func. class.: Migraine agent, abortive
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Chem. class.: Serotonin 5-HT1B/5HT1D receptor agonist (triptan)
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ACTION: Binds selectively to the vascular 5-HT1B/5HT1D receptor subtype, exerts antimigraine effect; causes Z vasoconstriction in cranial arteries
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USES: Acute treatment of migraine with/without aura
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CONTRAINDICATIONS: Angina pectoris, history of MI, documented silent ischemia, ischemic heart disease, uncontrolled hypertension, hypersensitivity, basilar or hemiplegic migraine, risk of CV events Precautions: Pregnancy, breastfeed ing, children, postmenopausal women, men >40 yr, geriatric patients, risk fac tors for CAD, hypercholesterolemia, obesity, diabetes, impaired renal/ hepatic function
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SIDE EFFECTS CNS: Tingling, hot sensation, burning, feeling of pressure, tightness, numb- ness, dizziness, sedation CV: Palpitations, chest pain GI: Abdominal discomfort, nausea, dry mouth, dyspepsia, dysphagia MISC: Odd taste (spray) MS: Weakness, neck stiffness, myalgia RESP: Chest tightness, pressure
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INTERACTIONS • Increase: Extended vasospastic effects: ergot, ergot derivatives, avoid using with ZOLMitriptan, space by 24 hr • Do not use within 2 wk of MAOIs • Increase: Weakness, hyperreflexia, incoordination: SSRIs (FLUoxetine, flu- voxaMINE, PARoxetine, sertraline), SNRI, methylene blue, traMADol Increase: half-life of ZOLMitriptan— cimetidine, oral contraceptives, monitor Drug/Herb • Increase: Serotonin syndrome: SAM-e, St. John’s wort Drug/Lab Test Increase: ALP
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DOSAGE AND ROUTES • Adult: PO start at 2.5 mg (tab may be broken), may repeat after 2 hr, max sin gle dose 5 mg, max 10 mg/24 hr; NASAL 1 spray in 1 nostril at onset of migraine, repeat in 2 hr if no relief
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Available forms: Tabs 2.5, 5 mg; orally disintegrating tabs 2.5, 5 mg; nasal spray 2.5, 5 mg
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Administer: PO route (conventional tablet) • Tablet may be split • Take with fluids as soon as symptoms of migraine occur • Not approved for more than 3-4 uses in a month • Orally disintegrating tab: do not crush or chew; allow to dissolve on tongue Nasal route • Blow nose before use • Remove top, insert in nostril, hold other nostril shut • Do not prime • Press on plunger while breathing gen tly through the nose • Discard for single use only
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Assess: • CNS/PANS: Assess for tingling, hot sensation, burning, feeling of pressure, numbness, flushing • Neurologic status: LOC, blurring vi sion, nausea, vomiting, tingling in ex tremities preceding headache • Diet and possible triggers: Ingestion of tyramine foods (pickled products, beer, wine, aged cheese), food additives, pre servatives, colorings, artifical sweeteners, chocolate, caffeine, which may precipi tate these types of headaches, use over 10 day/month may lead to exacerbation of headache • Serotonin syndrome if also taking SSRI, SNRI (agitation, tachycardia, hy- pertension, diarrhea, sweating, spasms/ rigidity) • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; may cause harm, death to fetus; do not breastfeed, excreted in breast milk
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Evaluate: • Therapeutic response: decrease in fre quency, severity of headache
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report any side effects to prescriber • To use contraception while taking prod uct • That product does not prevent or re duce number of migraines; not to use for other headaches • To report chest pain, rash, swelling of face, slurred speech • Not to double doses; if second dose is needed, wait at least 2 hr; disintegrating dosage form—do not split, break, alter; to remove from blister pack immediately be fore taking HIGH ALERT
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PHARMACOKINETICS Peak 11⁄2-3 hr (PO), 3 hr (nasal); 25% protein binding; half-life 3-31⁄2 hr; metabolized in liver (metabolite); excreted in urine (60%-80%), feces (20%-40%)
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• Adult: PO start at 2.5 mg (tab may be broken), may repeat after 2 hr, max sin gle dose 5 mg, max 10 mg/24 hr; NASAL 1 spray in 1 nostril at onset of migraine, repeat in 2 hr if no relief
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