Formulary
Zolmitriptan: Indications, Dosing, Side Effects and Interactions
Zolmitriptan clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Zolmitriptan: Indications, Dosing, Side Effects and Interactions
Zolmitriptan clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Treatment of acute migraine**
- **Adult** (By Mouth): 5 mg, dose to be administered as soon as possible after onset into one nostril only, followed by 5 mg after at least 2 hours if required, dose to be administered only if migraine recurs; maximum 10 mg per day.
**Menstrual migraine prophylaxis**
- **Adult** (By Mouth): 2.5 mg 3 times a day, to be taken from 2 days before until 3 days after bleeding starts.
**Treatment of acute migraine for zolmitriptan**
- **Child 12-17 years** (By mouth): 2.5 mg, followed by 2.5 mg after at least 2 hours if required, dose to be taken only if migraine recurs, if response unsatisfactory after 3 attacks consider increasing dose to 5 mg or switching to alternative treatment; maximum 10 mg per day.
- **Child 12-17 years** (By intranasal administration): 5 mg, dose to be administered as soon as possible after onset into one nostril only, followed by 5 mg after at least 2 hours if required, dose to be administered only if migraine recurs; maximum 10 mg per day.
**Treatment of acute cluster headache for zolmitriptan**
- **Child 12-17 years** (By intranasal administration): 5 mg, dose to be administered as soon as possible after onset into one nostril only, followed by 5 mg after at least 2 hours if required, dose to be administered only if migraine recurs; maximum 10 mg per day.
Cautions
Conditions which predispose to coronary artery disease; elderly
Contraindications
Arrhythmias associated with accessory cardiac conduction pathways; coronary vasospasm; ischaemic heart disease; moderate to severe hypertension; peripheral vascular disease; previous cerebrovascular accident; previous myocardial infarction; Prinzmetal's angina; transient ischaemic attack; uncontrolled hypertension; Wolff-Parkinson-White syndrome
Side effects
General side-effects: Common or very common Abdominal pain; asthenia; chest discomfort; dizziness; drowsiness; dry mouth; dysphagia; feeling hot; headache; limb discomfort; muscle weakness; nausea; pain; palpitations; sensation abnormal; vomiting Uncommon Tachycardia; urinary disorders Rare or very rare Angina pectoris; angioedema; coronary vasospasm; gastrointestinal disorders; gastrointestinal infarction; hypersensitivity; myocardial infarction; splenic infarction; urticaria Specific side-effects: Common or very common With intranasal use Feeling abnormal; haemorrhage; myalgia; nasal discomfort; taste altered; throat pain With oral use Muscle complaints; sensation of pressure; throat complaints Rare or very rare With oral use Diarrhoea Side-effects, further information Discontinue if symptoms of heat, heaviness, pressure or tightness (including throat and chest) occur.
Interactions
**Other interactions (17):**
- 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,...
- The pharmacokinetics and tolerability of zolmitriptan were unaffected by acute symptomatic treatments such as paracetamol, metoclopramide and ergotamine.
- Concomitant administration of other 5HT 1B/1D agonists within 24 hours of zolmitriptan treatment should be avoided.
- Similarly, administration of zolmitriptan within 24 hours with the use of other 5-HT 1B/1D agonists should also be avoided.
- Therefore, it is advised to wait at least 24 hours following the use of ergotamine containing preparations before administering zolmitriptan.
- Conversely it is advised to wait at least six hours following use of zolmitriptan before administering any ergotamine preparation (see Section 4.3).
Pregnancy
There is limited experience of using 5HT 1 -receptor agonists during pregnancy; manufacturers advise that they should be avoided unless the potential benefit outweighs the risk.
Breast feeding
Use with caution-present in milk in animal studies.
Hepatic impairment
Manufacturer advises caution in moderate to severe impairment (risk of increased exposure). Dose adjustments Manufacturer advises maximum 5 mg in 24 hours in moderate to severe impairment.
Medicinal forms
Tablet,Tablet,Spray
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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