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5-HT1B/1D Agonist (Triptan) Pregnancy: Avoid — limited data; sumatriptan has more safety data

Zolmitriptan

Brand names: Zomig

Adult dose

Dose: 2.5 mg oral at onset of migraine; may repeat after 2h if needed. Max 10 mg in 24h. Nasal spray: 5 mg per nostril; may repeat 5 mg after 2h.
Route: Oral or intranasal
Frequency: At migraine onset; may repeat after 2h
Max: 10 mg/24h
For acute migraine with or without aura. Not for prophylaxis. More lipid-soluble than sumatriptan — better CNS penetration. Nasal spray for rapid onset or when vomiting limits oral route.

Paediatric dose

Route: Oral or nasal
Frequency: Once; may repeat after 2h
Max: 5 mg per dose; 10 mg/24h
Concentration: Nasal spray 5 mg/actuation mg/ml
Adolescents ≥12 years: 2.5 mg oral or 5 mg nasal at migraine onset; max 5 mg per dose in adolescents. NICE: triptans licensed for adolescents ≥12 years.

Dose adjustments

Renal

No dose adjustment required

Hepatic

Reduce dose in moderate hepatic impairment — limit to 5 mg/24h

Clinical pearls

  • Triptans are abortive, NOT prophylactic — explain mechanism to patients clearly
  • Medication overuse headache (MOH): using triptans on ≥10 days/month can cause daily headache — regular review essential
  • Nasal spray faster onset than oral — useful when early vomiting
  • Cardiovascular risk check before prescribing triptans — screen for IHD, hypertension, and stroke history

Contraindications

  • Ischaemic heart disease
  • Coronary vasospasm
  • Peripheral vascular disease
  • Previous stroke or TIA
  • Hemiplegic or basilar migraine
  • Uncontrolled hypertension
  • Ergotamine or ergot derivatives within 24h
  • MAOIs within 14 days

Side effects

  • Chest tightness/pressure (usually non-cardiac)
  • Tingling/paraesthesia
  • Dizziness
  • Flushing
  • Nausea
  • Drowsiness
  • Nasal irritation (nasal spray)

Interactions

  • MAOIs — serotonin syndrome (avoid within 14 days)
  • Ergotamine — additive vasospasm (separate by 24h)
  • SSRIs/SNRIs — serotonin syndrome risk
  • Cimetidine — doubles zolmitriptan levels (reduce dose to 5 mg max)

Monitoring

  • Migraine frequency and severity diary
  • Medication overuse (>10 days/month)
  • Blood pressure
  • Cardiovascular symptoms

Reference: BNFc; BNF; NICE NG150 Headaches; British Association for the Study of Headache (BASH) Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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