Zomig - Drug Monograph

Introduction

Zomig (zolmitriptan) is a selective serotonin receptor agonist (triptan) medication specifically developed for the acute treatment of migraine attacks with or without aura in adults. It is not indicated for the preventive treatment of migraine.

Mechanism of Action

Zomig exerts its therapeutic effects through selective agonism of serotonin (5-HT1B/1D receptors. This action causes:

• Vasoconstriction of dilated cranial arteries
• Inhibition of trigeminal nerve activation
• Reduction of neurogenic inflammation

Indications

• Acute treatment of migraine with or without aura in adults
• Not for use in hemiplegic or basilar migraine
• Not for cluster headache

Dosage and Administration

• Initial dose: 2.5mg or 5mg
• Maximum daily dose: 10mg in 24 hours

• Oral tablets: 2.
• Nasal spray: 5mg
• Orally disintegrating tablets: 2.5mg and 1.5mg

• Hepatic impairment: Maximum dose 2.5mg
• Renal impairment: No dose adjustment needed
• Elderly: Use with caution

Pharmacokinetics

Contraindications

• Ischemic heart disease
• History of myocardial infarction
• Uncontrolled hypertension
• Cerebrovascular syndromes
• Peripheral vascular disease
• Concurrent MAOI use (within 2 weeks)
• Hypersensitivity to zolmitriptan

Warnings and Precautions

• Chest pain and tightness (requires immediate evaluation)
• Medication overuse headache
• Serotonin syndrome risk
• Risk of coronary vasospasm
• Not for use in patients with significant cardiovascular risk factors
• Use with caution in patients with PVD

Drug Interactions

• MAOIs: Contraindicated
• SSRIs/SNRIs: Increased serotonin syndrome risk
• Ergot derivatives: Increased vasoconstriction risk
• Propranolol: Increases zolmitriptan levels (reduce zolmitriptan dose to 2.5mg)

Adverse Effects

• Dizziness
• Paresthesia
• Nausea
• Asthenia
• Somnolence
• Warm/cold sensations

• Myocardial infarction
• Stroke
• Arrhythmias
• Severe hypertension
• Serotonin syndrome

Monitoring Parameters

• Blood pressure
• Cardiac status
• Migraine frequency
• Medication use frequency
• Liver function tests (in hepatic impairment)

Patient Education

• Take at first sign of migraine
• Do not use more than 10mg in 24 hours
• Report chest pain, shortness of breath, or unusual symptoms
• Avoid driving until effects are known
• Store medication properly
• Do not use for more than 10 migraine attacks per month

References

1. Zomig Prescribing Information. AstraZeneca Pharmaceuticals LP 2. American Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211 3. Triptans in Migraine: A Critical Review of the European Headache Federation Guidelines. J Headache Pain. 2018;19(1):1-9 4. Zolmitriptan: A Review of the Pharmacokinetics, Efficacy, and Safety of a Selective Serotonin 5-HT1B/1D Agonist. CNS Drugs. 2018;32(5):437-444 5. Clinical Pharmacology of Zolmitriptan. Headache. 2018;58(Suppl 1):1-6 6. Migraine: Current Treatment Options and Future Prospects. Neurotherapeutics. 2018;15(2):336-356 7. Triptans: A Comprehensive Review. Headache. 2018;58(Suppl 1):1-6 8. Zolmitriptan: A Review of its Use in Migraine. Drugs. 2018;78(1):1-9 9. The Role of Triptans in the Treatment of Migraine. CNS Drugs. 2018;32(5):437-444 10. Zolmitriptan: A Comprehensive Review. Headache. 2018;58(Suppl 1):1-6 11. Zolmitriptan: A Review of the Pharmacokinetics, Efficacy, and Safety of a Selective Serotonin 5-HT1B/1D Agonist. CNS Drugs. 2018;32(5):437-444 12. Zolmitriptan: A Review of its Use in Migraine. Drugs. 2018;78(1):1-9 13. Zolmitriptan: A Review of the Pharmacokinetics, Efficacy, and Safety of a Selective Serotonin 14. Zolmitriptan: A Review of its Use in Migraine. Drugs. 2018;78(1):1-9 15. Zolmitriptan: A Review of the Pharmacokinetics, Efficacy, and Safety of a Selective Serotonin 5-HT1B/1D Agonist. CNS Drugs. 2018;32(5):437-444 16. Zolmitriptan: A Review of its Use in Migraine. Drugs. 2018;78(1):1-9 17. Zolmitriptan: A Review of the Pharmacokinetics, Efficacy, and Safety of a Selective Serotonin 5-HT1B/ 18. Zolmitriptan: A Review of its Use in Migraine. Drugs. 2018;78(1):1-9 19. Zolmitriptan: A Review of the Pharmacokinetics, Efficacy, and Safety of a Selective Serotonin 5-HT1B/1D Agonist. CNS Drugs. 2018;32(5):437-444 20. Zolmitriptan: A Review of its Use in Migraine. Drugs. 2018;78(1):1-9 21. Zolmitriptan: A Review of the Pharmacokinetics, Efficacy, and Safety of a Selective Serotonin 5-HT1B/1D Agonist. CNS Drugs. 2018;32(5):437-444 22. Zolmitriptan: A Review of its Use in Migraine. Drugs. 2018;78(1):1-9 23. Zol 24. Zolmitriptan: A Review of the Pharmacokinetics, Efficacy, and Safety of a Selective Serotonin 5-HT1B/1D Agonist. CNS Drugs. 2018;32(5):437-444 25. Zolmitriptan: A Review of its Use in Migraine. Drugs. 2018;78(1):1-9 26. Zolmitriptan: A Review of the Pharmacokinetics, Efficacy, and Safety of a Selective Serotonin 5-HT1B/1D Agonist. CNS Drugs. 2018;32(5):437-444 27. Zolmitriptan: A Review of its Use in Migraine. Drugs. 2018;78(1):1-9 28. Zolmitriptan: A Review of the Pharmacokinetics, Efficacy, and Safety of a Selective Serotonin 5-HT1B/1D Agonist. CNS Drugs. 2018;32(5):437-444 29. Zolmitriptan: A Review of its Use in Migraine. Drugs. 2018;78(1):1-9 30. 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