ndication: Zolmitriptan is indicated for the acute treatment of migraine with or without aura.
Contraindication: Zolmitriptan is contraindicated in patients with known hypersensitivity to any component of the product. Zolmitriptan must not be given to patients with uncontrolled hypertension.
Side Effect: Zolmitriptan is well tolerated. Adverse reactions are typically mild/moderate, transient, not serious and resolve spontaneously without additional treatment. Possible adverse reactions tend to occur within 4 hours of dosing and are no more frequent following repeated dosing.
The following adverse reactions have been the most commonly reported: nausea; dizziness; somnolence; warm sensation; asthenia; dry mouth.
Abnormalities or disturbances of sensation have been reported; heaviness, tightness or pressure may occur in the throat, neck, limbs and chest (with no evidence of ischaemic changes on ECG), as may myalgia, muscle weakness, paraesthesia and dysaesthesia.
Precaution & Warning: Zolmitriptan should only be used where a clear diagnosis of migraine has been established. Care should be taken to exclude other potentially serious neurological conditions. There are no data on the use of Zolmitriptan in hemiplegic or basilar migraine.
Zolmitriptan should not be given to patients with symptomatic Wolff – Parkinson-White syndrome or arrhythmias associated with other cardiac accessory conduction pathways.
This class of compounds (5HT1D agonists) has been associated with coronary vasospasm; as a result, patients with ischaemic heart disease were excluded from clinical trials. Zolmitriptan is, therefore, not recommended in this patient group. In patients in whom unrecognised coronary artery disease is likely, cardiovascular evaluation prior to commencement of treatment with 5HT1D agonists is recommended.
As with other 5HT1D agonists, atypical sensations over the precordium have been reported after the administration of zolmitriptan, but in clinical trials these have not been associated with arrhythmias or ischaemic changes on ECG. Zolmitriptan may cause mild, transient increases in blood pressure (which may be more pronounced in the elderly), however, this has not been associated with clinical sequelae in the clinical trial programme.
Drug Interaction: There is no evidence that concomitant use of migraine prophylactic medications has any effect on the efficacy or unwanted effects of Zolmitriptan (for example beta blockers, oral dihydroergotamine, pizotifen). The pharmacokinetics and tolerability of Zolmitriptan were unaffected by acute symptomatic treatments such as paracetamol, metoclopramide and ergotamine. However, it is recommended that patients should leave at least 6 hours between taking an ergotamine preparation and starting Zolmitriptan, and vice versa. Concomitant administration of other 5HT1D agonists within 12 hours of Zolmitriptan treatment should be avoided.
Following administration of moclobemide, a specific MAO-A inhibitor, there was a small increase (26%) in AUC for zolmitriptan and a 3-fold increase in AUC of the active metabolite. Therefore, a maximum intake of 7.5 mg Zolmitriptan in 24 hours is recommended in patients taking an MAO-A inhibitor.
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