Zolmitriptan (Zomig)

Zolmitriptan, often sold under the brand name Zomig, is an acute migraine medication that delivers instant relief from migraine attack symptoms, such as headache pain, light sensitivity and nausea. It is not used to prevent migraine attacks, however. It can also be used for cluster headaches.

It is available as tablets. Alternatively, it is also available as a nasal spray or orodispersible tablets here at euroClinix for those who have difficulty swallowing tablets. You must have been diagnosed with migraine by a medical professional to be prescribed Zolmitriptan online.

Zolmitriptan belongs to a group of medicines known as selective serotonin receptor agonists (5-HT1-agonists) or more commonly as ‘triptans’. Triptans including Almotriptan, Sumatriptan (Imigran), Naratriptan, Rizatriptan, Frovatriptan and Eletriptan are the most effective and common drugs to treat migraine attacks.

These medications specifically stimulate the production of serotonin, an important chemical messenger in the brain (neurotransmitter). By doing so, it reduces inflammation and constricts blood vessels in the brain which is believed to cause migraine. This quickly reduces migraine headache and the other symptoms associated with it such as aura, light & sound sensitivity and nausea.

Research has shown that Zolmitriptan and other triptans can be used to treat neurological symptoms (e.g aura, speech disturbance and vertigo) of rarer types of migraine such as basilar migraine and vestibular migraine.

You should only take Zolmitriptan if you have been diagnosed with migraine by a medical professional. You should not taken Zolmitriptan if you have:

• had an allergic reaction to Zolmitriptan or any of the listed ingredients
• untreated high blood pressure
• had heart problems such as angina or a heart attack
• had a stroke or mini-stroke (transient ischaemic attack, TIA)

If you have certain pre-existing conditions, Zolmitriptan is safe for you to take but you may require some additional monitoring such as if you have:

• been told you are at risk of heart disease (i.e if you smoke, have a high BMI, high cholesterol, high blood pressure, diabetes or have a family history of heart disease)
• Wolff-Parkinson-White Syndrome (a condition that causes an irregular heartbeat)
• a history of liver problems
• unusual headaches that don’t feel like your typical migraine headaches

If you are not sure whether you fall under any of these categories, you should speak to a healthcare professional.

Zolmitriptan is available as both tablets and a nasal spray, both of which work quickly to alleviate symptoms. They work best if you take them as soon as you feel a migraine coming on. Zolmitriptan cannot be used to prevent migraines, that kind of treatment will need to be prescribed and monitored by your primary doctor.

The maximum dose of Zolmitriptan tablets or the nasal spray you can take is 10mg a day. If you take more than 10mg, you should seek immediate medical advice even if you feel fine.

Comprehensive instructions on how to take the tablets and nasal spray can be found in their respective patient information leaflets.

Zolmitriptan tablets

Zolmitriptan is available in 2.5mg tablets, 5mg tablets and 5mg orodispersible tablets. You can purchase film-coated tablets or orodispersible tablets if you have difficulty swallowing tablets.

You should take one tablet as soon as you feel symptoms developing or during the migraine attack. You should swallow the tablet with a drink of water.

If you are prescribed orodispersible tablets, you must place one tablet on your tongue and wait for it to dissolve. It should dissolve quickly.

If symptoms are still present 2 hours after the first dose or return within a 24 hour-period, take another tablet. Do not take more than 10mg a day, however.

Zolmitriptan nasal spray

The nasal spray is available in a 5mg dose.

One 5mg dose should be sprayed into one nostril, it doesn’t matter which nostril you choose to spray it into. You can do so at the beginning of or during an attack.

If your symptoms persist after 2 hours or return after 24 hours, you can take another 5mg dose. You should not exceed 2 doses a day.

A full set of instructions with diagrams is available in the patient information leaflet, but a brief summary of how to administer the nasal spray is as follows:

1. Blow your nose gently before use.
2. Remove protective cover, gently hold the nasal spray between your finger and thumb but do not press the plunger yet.
3. Block one nostril by pressing your finger to the side of your nose.
4. Insert nozzle into the other nostril as far as it feels comfortable to do so.
5. Tilt your head back slightly and close your mouth.
6. Breathe gently in through your nose and press the plunger firmly with your thumb at the same time. You may hear it click.
7. Keeping your head tilted, remove the nozzle from your nose.
8. Breathe gently through your mouth for 5 - 10 seconds, the inside of your nose may feel wet but this is normal and doesn’t mean the spray hasn’t worked.

Like all prescription medicines, Zolmitriptan can cause some side effects. However, the most common side effects are mild and go away quickly.

Common side effects include:

Some more severe side effects are rare but may include an allergic reaction (swelling, itchy rash) or chest pain (angina). A more comprehensive list of side effects is available in the patient information leaflet. If you experience any worrying or prolonged symptoms, please seek immediate medical advice.

You should speak to your doctor if you are pregnant or breastfeeding. It is not known if it is harmful to the baby, but it is always best to speak to your doctor first.

Whilst Zolmitriptan won’t have any effect on your ability, the migraine attack itself may affect your ability to drive or use heavy machinery. You should understand how your migraine affects you before trying any of these activities.

Taking Zolmitriptan, other triptans, ergot-type medicines, NSAIDs or other painkillers for your migraine regularly can also exacerbate your migraines. This phenomenon is known as medicine overuse headache (MOH) which occurs when people overuse these medicines. If you find yourself regularly taking Zolmitriptan or other acute migraine medicines more than 10 days each month, you may benefit from preventative migraine treatment.

Other medicines and Zolmitriptan

Zolmitriptan can cause adverse effects from certain drug interactions, so you should always notify your prescriber of any medications you take including any prescription or over-the counter medicines; recreational drugs or herbal supplements.

In particular, you should notify the prescriber if you take any antidepressants as taking them with any migraine medication can cause serotonin syndrome, where your serotonin levels are too high.

Whilst rare, you should still take caution if you take antidepressants such as:

• SSRIs (selective serotonin reuptake inhibitors) e.g sertraline, citalopram, fluoxetine, paroxetine, fluvoxamine or sertraline
• SNRIs (serotonin norepinephrine reuptake inhibitors) e.g venlafaxine or duloxetine
• MAOIs (mono-amine oxidase inhibitors) e.g moclobemide or tranylcypromine

Zolmitriptan may react with certain other medicines, including:

• cimetidine - for stomach ulcers or indigestion
• quinolone antibiotics e.g ciprofloxacin
• St. John’s wort - herbal remedy used for depression

If you already take medicines for migraine, you may need to adjust your dosage whilst taking Zolmitriptan such as:

• other triptans besides Zolmitriptan (e.g sumatriptan or naratriptan) - allow for 24 hours before you use Zolmitriptan, and wait 24 hours after taking Zolmitriptan before taking your other triptan
• ergot-type medicines (e.g ergotamine or dihydroergotamine) - allow for 24 hours before taking Zolmitriptan, then wait 6 hours before using an ergot-type medicine

If you’re not sure whether you take any of these medicines, please speak to your doctor or pharmacist before taking Zolmitriptan.

Both Zolmitriptan tablets and nasal spray are available to purchase for the treatment of migraine at euroClinix. However, you must have been previously diagnosed with migraine by a medical professional. To purchase, all you have to do is fill out a quick and confidential medical questionnaire that will be reviewed by one of our doctors. Once they have approved, your medication will be dispensed and dispatched with free next-day delivery.