Zomig (zolmitriptan)

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Zomig is a serotonin (5-HT) receptor agonist that is used in the treatment of acute migraines in adults. The active ingredient in Zomig is zolmitriptan, a selective serotonin receptor agonist.  It is classified as a triptan, which is believed to reduce the pain of migraine by relieving swelling and narrowing blood vessels. As a selective serotonin receptor agonist, Zomig also stops pain signals being sent to the brain and blocks the release of certain chemicals in the body that cause the symptoms of migraine, including head pain, nausea, and sensitivity to light and sound. Zomig is indicated for migraines with or without aura, the visual or sensory symptoms some people with migraines experience before the head pain.1,2

Zomig was first approved to treat migraines in 1997 in a tablet formulation. It is now also available in an orally dissolving tablet (Zomig ZMT) and as a nasal spray. The tablets and orally dissolving tablets are available in generic forms under the name zolmitriptan.1,3

How does Zomig work?

The zolmitriptan in Zomig binds to certain serotonin receptors. Researchers believe that Zomig works by binding to these receptors in neurons (nerve cells) and on blood vessels in the brain, causing the blood vessels to constrict and inhibiting chemicals that would increase inflammation. Zomig also reduces substances that trigger head pain and which may be involved in other common symptoms of migraine, such as nausea, sensitivity to light, and sensitivity to sound. Zomig works best when it is taken at the first sign of a migraine. It does not prevent a migraine or reduce the number of migraine attacks you have.1-3

What are the possible side effects of Zomig?

Like all medications, Zomig may cause unintended side effects. The most common side effects experienced by people taking Zomig tablets are pain, tightness or pressure in the neck, throat, or jaw; dizziness, tingling, weakness or lack of energy, sleepiness, feelings of warmth or cold, nausea, heaviness sensation, and dry mouth. The most common side effects experienced by people taking Zomig nasal spray are an unusual taste, tingling, dizziness, and sensitivity of the skin, especially the skin around the nose.1,4

Rarely, Zomig may cause serious side effects, including heart attack, increased blood pressure, stroke, life-threatening disturbances of the heart rhythm, constriction of blood flow to the abdomen or other parts of the body, or serious allergic reactions. If you experience serious side effects with Zomig, you should seek immediate medical attention.

Signs of serious side effects include:

  • Severe pain, tightness, pressure or heaviness in the chest, throat, neck or jaw that does not go away
  • Slurring of speech
  • Sudden weakness or numbness
  • Changes in color to the fingers or toes (like paleness or a bluish tint)
  • Allergic reactions, such as hives, swelling of the eyes, face, lips, or throat or difficulty breathing.1,3

Before using Zomig, talk to your doctor about all your medical conditions, particularly if you have:

  • High blood pressure
  • High cholesterol
  • Diabetes
  • Liver disease
  • Overweight
  • Personal or family history of heart disease or stroke
  • History of circulation problems, like varicose veins, blood clots, Raynaud’s disease, or ischemic bowel disease
  • Pregnancy or planning to become pregnant
  • Breastfeeding or planning to breastfeed
  • Past menopause 1,3

Things to know about Zomig

People with any of the following health conditions should not use Zomig or its generic zolmitriptan:

  • History of heart disease or coronary artery vasospasm
  • Wolff-Parkinson-White syndrome or other cardiac accessory conduction pathway disorders
  • History of stroke, transient ischemic attack (“mini stroke), or hemiplegic or basilar migraine
  • Peripheral vascular disease
  • Ischemic bowel disease
  • Uncontrolled high blood pressure (hypertension)
  • Hypersentivity to zolmitriptan1

In addition, people taking certain medications should not use Zomig, including:

  • Recent use (within 24 hours) of another selective serotonin receptor agonist or another triptan
  • Recent use of an ergotamine-containing medication
  • Use of a monoamine oxidase A (MAO-A) inhibitor within the last 2 weeks1

Talk to your doctor or pharmacist about all prescription and over-the-counter medications you are taking, as well as any vitamins, nutritional supplements, and herbal products you take, as some of these may interact with Zomig.1,2

Dosing information

The tablet comes in dosage of 2.5 mg and 5mg. A dosage of 1.25 mg can be achieved by breaking the 2.5 mg tablet in half along the centerline; however, the dissolving tablets should not be broken or split. The tablet should be taken at the first sign of a migraine. If migraine symptoms improve but return or worsen after 2 hours, a second dose may be taken. However, the maximum amount anyone should take in a 24-hour period is 10 mg.1,2

The nasal spray administers single doses of 2.5 mg or 5 mg of zolmitriptan. The recommended starting dose is 2.5 mg, and the maximum single dose is 5 mg. A second dose of the nasal spray may be used if symptoms return after two hours, but the maximum dose anyone should take in a 24-hour period is 10 mg.4