Zolmitriptan is a selective agonist for serotonin (5HT1 receptors). It relieves migraine by selective constriction of intracranial blood vessels, neuropeptide release inhibition and decreased transmission in the trigeminal pain pathway.

Indication: acute migraine attacks

Oral
Adult: initially, 2.5 mg. A second dose may be taken at least 2 hr after the first dose if symptoms recur within 24 hr. Max dose: 10 mg in 24 hr. Safety of treating > 3 headaches in a 30-day period has not been established.
Hepatic impairment: dose reduction may be needed with BP monitoring. Moderate to severe: max dose: 5 mg/24 hr.

Nasal
Acute migraine attacks
Adult: 5 mg (1 spray) into 1 nostril as soon as possible after onset of symptoms, repeated at least 2 hr after the first dose if symptoms recur w/in 24 hr. Max: 10 mg/day. Safety of treating >4 headaches in a 30 day period is not established.
Hepatic impairment: avoid use.

Special populations: concurrent use with cimetidine, quinolone antibacterials, max dose: 5 mg in 24 hr.

Drug interactions: increased risk of serotonin syndrome with SSRI, selective serotonin- and norepinephrine-reuptake inhibitors (SNRI). Increased zolmitriptan concentrations with cimetidine, quinolone antibacterials, etc.

See reference for details.

Adapted from CIMS Drug Information System. Internet. Accessed on January 10, 2016.