What is Zomig (zolmitriptan)?

Zomig (zolmitriptan) is a type of headache medicine (a “triptan”) used to treat migraine headaches. Migraine headaches are believed to result from dilation of the blood vessels in the brain. 

Zomig causes constriction of the blood vessels and thereby relieves the pain of a migraine headache. While Zomig is effective in relieving migraine headaches, it does not prevent or reduce the number of headaches if taken prophylactically. 

Common side effects of Zomig are usually temporary and include:

Serious side effects of Zomig include allergic reactions.

  • Symptoms include:

Drug interactions of Zomig include monoamine oxidase inhibitors (MAOIs), which may exaggerate the effects of Zomig. 

Serotonin reuptake inhibitors (SSRIs) taken with Zomig may lead to exaggerated effects of serotonin, which can include weakness, increased reflexes, and loss of coordination. 

Combining ergots and Zomig may result in exaggerated spasm of blood vessels. 

Cimetidine taken with Zomig may lead to Zomig toxicity. 

Safe use of Zomig in pregnancy has not been established. Safe use of Zomig in breastfeeding mothers has not been established. Pregnant or breastfeeding women should consult their doctors.

What are the important side effects of Zomig (zolmitriptan)?

Side effects are generally transient. Some common side effects include:

  • pain or tightness in the chest or throat,
  • tingling sensations,
  • flushing,
  • weakness,
  • dizziness,
  • abdominal discomfort, and
  • sweating.

Rarely, allergic reactions (even shock) have been reported though usually in individuals who are highly allergic to many substances.

Zomig (zolmitriptan) side effects list for healthcare professionals

The following adverse reactions are described elsewhere in other sections of the prescribing information:

Clinical Trials Experience

Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to rates in the clinical studies of another drug and may not reflect the rates observed in practice.

In a long-term, open-label study where patients were allowed to treat multiple migraine attacks for up to 1 year, 8% (167 out of 2,058) withdrew from the trial because of adverse reaction.

The most common adverse reactions (≥ 5% and > placebo) in these trials were neck/throat/jaw pain, dizziness, paresthesia, asthenia, somnolence, warm/cold sensation, nausea, heaviness sensation, and dry mouth.

Table 1 lists the adverse reactions that occurred in = 2% of the 2,074 patients in any one of the Zomig 1 mg, 2.5 mg, or 5 mg dose groups in the controlled clinical trials of Zomig in patients with migraines (Studies 1, 2, 3, 4, and 5). Only adverse reactions that were at least 2% more frequent in a Zomig group compared to the placebo group are included.

Several of the adverse reactions appear dose related, notably paresthesia, sensation of heaviness or tightness in chest, neck, jaw, and throat, dizziness, somnolence and possibly asthenia and nausea.

Table 1: Adverse Reaction Incidence in Five Pooled Placebo-Controlled Migraine Clinical Trials1

  Placebo
(n=401)
Zomig 1 mg
(n=163)
Zomig 2.5 mg
(n=498)
Zomig 5 mg
(n=1012)
ATYPICAL SENSATIONS 6% 12% 12% 18%
Paresthesia (all types) 2% 5% 7% 9%
Warm/cold sensation 4% 6% 5% 7%
PAIN AND PRESSURE SENSATIONS 7% 13% 14% 22%
Chest - pain/tightness/pressure and/or heaviness 1% 2% 3% 4%
Neck/throat/jaw -pain/tightness/pressure 3% 4% 7% 10%
Heaviness other than chest or neck 1% 1% 2% 5%
Other- Pressure/tightness/heaviness 0 2% 2% 2%
DIGESTIVE 8% 11% 16% 14%
Dry mouth 2% 5% 3% 3%
Dyspepsia 1% 3% 2% 1%
Dysphagia 0% 0% 0% 2%
Nausea 4% 4% 9% 6%
NEUROLOGICAL 10% 11% 17% 21%
Dizziness 4% 6% 8% 10%
Somnolence 3% 5% 6% 8%
Vertigo 0% 0% 0% 2%
OTHER        
Asthenia 3% 5% 3% 9%
Sweating 1% 0% 2% 3%
1 Only adverse reactions that were at least 2% more frequent in a Zomig group compared to the placebo group are included.

There were no differences in the incidence of adverse reactions in controlled clinical trials in the following subgroups: gender, weight, age, use of prophylactic medications, or presence of aura. There were insufficient data to assess the impact of race on the incidence of adverse reactions.

Less Common Adverse Reactions with Zomig Tablets

In the paragraphs that follow, the frequencies of less commonly reported adverse clinical reactions are presented. Because the reports include reactions observed in open and uncontrolled studies, the role of Zomig in their causation cannot be reliably determined. Furthermore, variability associated with adverse reaction reporting, the terminology used to describe adverse reactions, etc., limit the value of the quantitative frequency estimates provided. Adverse reaction frequencies were calculated as the number of patients who used Zomig tablets and reported a reaction divided by the total number of patients exposed to Zomig tablets (n=4,027). Reactions were further classified within body system categories and enumerated in order of decreasing frequency using the following definitions: infrequent adverse reactions (those occurring in 1/100 to 1/1,000 patients) and rare adverse reactions (those occurring in less than 1/1,000 patients).

General: Infrequent were allergic reactions.

Cardiovascular: Infrequent were arrhythmias, hypertension, and syncope. Rare was tachycardia.

Neurological: Infrequent were agitation, anxiety, depression, emotional lability and insomnia; Rare were amnesia, hallucinations, and cerebral ischemia.

Skin: Infrequent were pruritus, rash and urticaria.

Urogenital: Infrequent were polyuria, urinary frequency and urinary urgency.

Adverse Reactions with Zomig-ZMT Oral Disintegrating Tablets

The adverse reaction profile seen with Zomig-ZMT oral disintegrating tablets was similar to that seen with Zomig tablets.

Postmarketing Experience

The following adverse reactions were identified during post approval use of Zomig. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

The reactions enumerated include all except those already listed in the Clinical Trials Experience section above or the Warnings and Precautions section.

Hypersensitivity Reactions:

As with other 5-HT1B/1D agonists, there have been reports of anaphylaxis, anaphylactoid, and hypersensitivity reactions including angioedema in patients receiving Zomig. Zomig is contraindicated in patients with a history of hypersensitivity reaction to Zomig.

What drugs interact with Zomig (zolmitriptan)?

Ergot-containing Drugs

Ergot-containing drugs have been reported to cause prolonged vasospastic reactions. Because these effects may be additive, use of ergotamine-containing or ergot-type medications (like dihydroergotamine or methysergide) and Zomig within 24 hours of each other is contraindicated).

MAO-A Inhibitors

MAO-A inhibitors increase the systemic exposure of zolmitriptan and its active N-desmethyl metabolite. Therefore, the use of Zomig in patients receiving MAO-A inhibitors is contraindicated.

5-HT1B/1D Agonists

Concomitant use of other 5-HT1B/1D agonists (including triptans) within 24 hours of Zomig treatment is contraindicated because the risk of vasospastic reactions may be additive).

Selective Serotonin Reuptake Inhibitors And Serotonin Norepinephrine Reuptake Inhibitors

Cases of life-threatening serotonin syndrome have been reported during co-administration of triptans and selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs).

Cimetidine

Following administration of cimetidine, the half-life and blood levels of zolmitriptan and its active N-desmethyl metabolite were approximately doubled. If cimetidine and Zomig are used concomitantly, limit the maximum single dose of Zomig to 2.5 mg, not to exceed 5 mg in any 24-hour period.

Summary

Zomig (zolmitriptan) is a type of headache medicine (a “triptan”) used to treat migraine headaches. Common side effects of Zomig are usually temporary and include pain or tightness in the chest or throat, tingling sensations, flushing, weakness, dizziness, abdominal discomfort, and sweating. Serious side effects of Zomig include allergic reactions (symptoms include hives; difficulty breathing; swelling of the face, lips, tongue, or throat) and shock (rare). Safe use of Zomig in pregnancy has not been established. Safe use of Zomig in breastfeeding mothers has not been established.

Treatment & Diagnosis

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Medically Reviewed on 4/29/2020
References
FDA Prescribing Information

Professional side effects and drug interactions sections courtesy of the U.S. Food and Drug Administration.
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