1% to 10%:

Cardiovascular: Chest pain (2% to 4%), palpitation (up to 2%)

Central nervous system: Dizziness (6% to 10%), somnolence (5% to 8%), pain (2% to 3%), vertigo (2%)

Gastrointestinal: Nausea (4% to 9%), xerostomia (3% to 5%), dyspepsia (1% to 3%), dysphagia (2%)

Neuromuscular & skeletal: Paresthesia (5% to 9%), weakness (3% to 9%), warm/cold sensation (5% to 7%), hypesthesia (1% to 2%), myalgia (1% to 2%), myasthenia (up to 2%)

Miscellaneous: Neck/throat/jaw pain (4% to 10%), diaphoresis (up to 3%), allergic reaction (up to 1%)

<1% Agitation, akathisia, alkaline phosphatase increase, amnesia, anorexia, anxiety, apathy, apnea, appetite increased, arrhythmia, arthritis, ataxia, back pain, bradycardia, bronchitis, bronchospasm, bruising, cerebral ischemia, chills, constipation, cyanosis, cystitis, depression, diplopia, dry eyes, dysmenorrhea, dystonia, ear pain, edema, emotional lability, eosinophilia, epistaxis, esophagitis, extrasystole, euphoria, eye pain, facial edema, fever, gastritis, gastroenteritis, hallucinations, hematemesis, hematuria, hiccups, hyperacusis, hyperesthesia, hyperglycemia, hyperkinesias, hypertension, hypertensive crisis, hypertonia, hypotonia, insomnia, irritability, lacrimation, laryngitis, leg cramps, leukopenia, liver function abnormality, malaise, melena, miscarriage, pancreatitis, parosmia, photosensitivity, polyuria, postural hypotension, pruritus, QT prolongation, rash, syncope, tachycardia, tenosynovitis, tetany, thirst, thrombocytopenia, thrombophlebitis, tinnitus, tongue edema, twitching, ulcer, urinary frequency, urinary urgency, urticaria, voice alteration, yawning

Postmarketing and/or case reports: Anaphylactoid reaction, anaphylaxis, angina pectoris, coronary artery vasospasm, gastrointestinal infarction/necrosis, headache, ischemic colitis, MI, myocardial ischemia, splenic infarction

Events related to other serotonin 5-HT1D receptor agonists: Cerebral hemorrhage, stroke, subarachnoid hemorrhage, peripheral vascular ischemia, ventricular fibrillation

Cimetidine: Zolmitriptan serum levels increased; avoid concurrent use

Ergot-containing drugs (dihydroergotamine, methysergide): Concurrent use may lead to vasospastic reactions; separate use by at least 24 hours.

MAO inhibitors: Increases systemic exposure to zolmitriptan. Avoid concurrent use and use within 2 weeks of discontinuing a MAO inhibitor. Selegiline (selective MAO type B inhibitor) does not affect zolmitriptan levels.

Oral contraceptives: Zolmitriptan serum levels increased with concurrent use.

Propranolol: Increased zolmitriptan toxicity

Selective serotonin reuptake inhibitors (SSRIs): Concurrent use may lead to serotonin syndrome.

Sibutramine: Concurrent use may lead to serotonin syndrome.

Onset of action: 0.5-1 hour

Absorption: Well absorbed

Distribution: Vd: 7 L/kg

Protein binding: 25%

Metabolism: Converted to an active N-desmethyl metabolite (2-6 times more potent than zolmitriptan)

Half-life elimination: 2.8-3.7 hours

Bioavailability: 40%

Time to peak, serum: Tablet: 1.5 hours; Orally-disintegrating tablet and nasal spray: 3 hours

Excretion: Urine (~60% to 65% total dose); feces (30% to 40%)

Children: Safety and efficacy have not been established

Adults: Migraine:

Tablet: Initial: 2.5 mg at the onset of migraine headache; may break 2.5 mg tablet in half

Orally-disintegrating tablet: Initial: 2.5 mg at the onset of migraine headache

Nasal spray: Initial: 1 spray (5 mg) at the onset of migraine headache

Note: Use the lowest possible dose to minimize adverse events. If the headache returns, the dose may be repeated after 2 hours; do not exceed 10 mg within a 24-hour period. Controlled trials have not established the effectiveness of a second dose if the initial one was ineffective

Elderly: No dosage adjustment needed but elderly patients are more likely to have underlying cardiovascular disease and should have careful evaluation of cardiovascular system before prescribing.

Dosage adjustment in renal impairment: No dosage adjustment recommended. There is a 25% reduction in zolmitriptan's clearance in patients with severe renal impairment (Clcr 5-25 mL/minute)

Dosage adjustment in hepatic impairment: Administer with caution in patients with liver disease, generally using doses <2.5 mg. Patients with moderate-to-severe hepatic impairment may have decreased clearance of zolmitriptan, and significant elevation in blood pressure was observed in some patients.

Tablet: May be broken

Orally-disintegrating tablet: Must be taken whole; do not break, crush or chew; place on tongue and allow to dissolve; administration with liquid is not required

Nasal spray: Blow nose gently prior to use. After removing protective cap, instill device into nostril. Block opposite nostril; breathe in gently through nose while pressing plunger of spray device. One dose (5 mg) is equal to 1 spray in 1 nostril.

This agent is intended to relieve migraine, but not to prevent or reduce the number of attacks. Use only to treat an actual migraine attack.

Solution, nasal spray [single dose] (Zomig®): 5 mg/0.1 mL (0.1 mL)

Tablet (Zomig®): 2.5 mg, 5 mg

Tablet, orally-disintegrating (Zomig-ZMT™): 2.5 mg [contains phenylalanine 2.81 mg/tablet; orange flavor]; 5 mg [contains phenylalanine 5.62 mg/tablet; orange flavor]