zolmitriptan

Indications & Dose:

Treatment of acute migraine with or without aura

DOSE

Adult

2.5 mg as soon as possible after onset repeated after 2 hours if migrain persist or recurs (increase to 5mg for subsquent attacks in patients not achieving satisfactory relief with 2.5mg dose); max.15mg in 24 hours

Children

Not recommended 

Contraindications:

Ischemic heart disease, coroner artery vasospasm, significant underlying cardiovascular disease; uncontrolled hypertension; use within 24 hr of another 5 HT, agonist, or an ergotamine containing or ergot type medication (e.g. dihydroergotamine or methysergide); hemiplegic or basilar migraine; within 2 weeks MAO inhibitor therapy; symptomatic Wolff Parkinson White syndrome 

Side Effects:

CNS: Agitation, anxiety, depression, dizziness, emotional lability, insomnia, somnolence, vertigo

CV: Bradycardia, chest pain, dysrhythmia; edema, extrasystoles, hypertension, palpitations; postural hypotension. pressure car heaviness; syncope tightness

EENT: Dry eyes, ear pain, eye pain, tinnitus

GI: Dry mouth, dyspepsia, dysphagia, nausea

GU: Hematuria, polyuria, urinary frequency, urinary urgency

MS: Myalgia, myasthenia RESP: Bronchospasm, hiccup, laryngitis, yawning

SKIN: Pruritus, rash, sweating, urticaria

MISC: Asthenia; hyperesthesia, neck, throat, jaw pain, paresthesia, pressure or tightness, warm or cold sensations 

Cautions:

Precautions:

Hypertension, hypercholesterolemia, smokers, obesity, diabetes, strong family history of early CAD, peripheral vascular disease, irepaired hepatic function (initiate therapy with low dose) 

Interaction:

acetaminophen: Delayed peak effect of acetaminophen (by 1 hour)

cimetidine: Prolonged zolmitriptan half-life ergot alkaloids: Prolonged vasoconstriction effects fluoxetine, fluvoxamine, paroxetine, sertraline:

Hyperreflexia, lack of coordination, and weakness

MAO inhibitors: Increased zolmitriptan effects naratriptan, rizatriptan, sumatriptan:

Prolonged zolmitriptan effects

oral contraceptives, propranolol: Increased blood zolmitriptan level

serotonin and norepinephrine reuptake inhibitors: Increased risk of developing serotonin syndrome 

Warnings:

Monitor patient for signs and symptoms of vasoconstriction, which may lead to vascular and colonic ischemia with abdominal pain and bloody diarrhea, especially if patient has peripheral vascular disease (including Raynaud’s phenomenon) or ischemic bowel disease.

• Monitor elderly patients and those with hepatic impairment for increased blood pressure, and notify prescriber immediately if it occurs.

• Monitor patient closely for signs and symptoms of angina. If patient develops chest pain, notify prescriber.

WARNING

Monitor patient closely for signs and symptoms of serotonin syndrome, which may include agitation, hallucina-tions, coma, tachycardia, labile blood pressure, hyperthermia, hyperreflexia, incoordination, nausea, vomiting, and diarrhea. Notify prescriber immediately because serotonin syndrome may be lifethreatening. Be prepared to provide supportive care and discontinue zolmitriptan.

PATIENT TEACHING

• Urge patient to consult prescriber before treating more than three headaches in 30 days.

• Advise patient not to remove disintegrat-ing tablet from blister pack until just before taking the tablet. Instruct her to peel open pack, let tablet dissolve on her tongue, and then swallow.

• Urge patient to notify prescriber about unusual or severe adverse reactions

. • Caution patient using nasal spray to avoid spraying drug into her eyes.

Adverse Effects:

Lactations:

 Excretion into breast milk unknown, use caution in nursing mothers 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Asthenia, dizziness, hyperesthesia, paresthesia, somnolence, vertigo

CV: Angina, coronary artery vasospasm, hypertension, MI, palpitations, transient myocardial ischemia, ventricular fibrillation or tachycardia

EENT: Dry mouth, vision disturbance

GI: Abdominal pain, bloody diarrhea, dysphagia, GI or splenic infarction, indiges-tion, ischemic colitis, nausea, vomiting

MS: Myalgia; myasthenia; pain, pressure, or tightness in jaw, neck, or throat

SKIN: Diaphoresis, flushing

Other: Anaphylaxis, anaphylactoid reaction, angioedema 

Patient And Carer Advice: