Home Drug Guide Zolmitriptan

Drug Guide

Generic Name

Zolmitriptan

Brand Names Zomig, Zomig-zmt

Classification

Therapeutic: Antimigraine agent

Pharmacological: Serotonin receptor agonist (5-HT1B/1D receptor agonist)

FDA Approved Indications

Acute treatment of migraine attacks with or without aura

Mechanism of Action

Zolmitriptan activates 5-HT1B and 5-HT1D receptors in cranial blood vessels and sensory nerves, leading to vasoconstriction and inhibition of neuropeptide release, which alleviates migraine symptoms.

Dosage and Administration

Adult: Typically 1.25 mg to 2.5 mg taken at onset of migraine. May repeat after 2 hours if needed, not exceeding 10 mg in 24 hours.

Pediatric: Not typically recommended for children under 12 years; consult specific pediatric dosing guidelines.

Geriatric: Use with caution; start at lower end of dosing range due to increased sensitivity and comorbidities.

Renal Impairment: Adjust dose in moderate to severe impairment; consult specific guidelines.

Hepatic Impairment: Use with caution; start at lower dose and monitor response.

Pharmacokinetics

Absorption: Rapid absorption with oral administration.

Distribution: Widely distributed; crosses the blood-brain barrier.

Metabolism: Primarily hepatic via CYP1A2 enzymes.

Excretion: Excreted mainly in urine, both as metabolites and unchanged drug.

Half Life: Approximately 3 hours.

Contraindications

History of cerebrovascular or coronary artery disease
Uncontrolled hypertension
Use with monoamine oxidase inhibitors within 14 days

Precautions

Assess cardiac risk before use, especially in patients with risk factors for coronary artery disease.
Monitor blood pressure during therapy.

Adverse Reactions - Common

Dizziness (Occasional)
Somnolence (Uncommon)
Nausea (Uncommon)

Adverse Reactions - Serious

Serious cardiovascular events (e.g., heart attack, arrhythmia) (Rare)
Serotonin syndrome (if combined with other serotonergic agents) (Rare)

Drug-Drug Interactions

Other serotonergic drugs (e.g., SSRIs, SNRIs, MAOIs)
Ergot alkaloids

Drug-Food Interactions

Avoid alcohol and certain foods that may elevate blood pressure

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for cardiovascular history, baseline blood pressure, and migraine characteristics.

Diagnoses:

Risk for cardiovascular complications
Ineffective pain management

Implementation: Administer at onset of migraine, observe for adverse reactions, especially cardiovascular symptoms.

Evaluation: Assess effectiveness in reducing migraine severity and frequency.

Patient/Family Teaching

Instruct on timing of medication intake at migraine onset.
Warn about possible side effects and when to seek medical attention.
Advise against concurrent use of other serotonergic drugs without medical advice.

Special Considerations

Black Box Warnings:

Coronary artery disease, other significant underlying cardiovascular conditions

Genetic Factors: CYP1A2 genetic variations may affect drug metabolism.

Lab Test Interference: None documented.

Overdose Management

Signs/Symptoms: Dizziness, vertigo, hypertension, somnolence, coma in severe cases.

Treatment: Supportive care; manage symptoms; activated charcoal if ingestion is recent; no specific antidote.

Storage and Handling

Storage: Store at room temperature, away from moisture and heat.

Stability: Stable under recommended storage conditions.