Zolmitriptan Nasal (patient information)

# Why is this medication prescribed
Zolmitriptan is used to treat the symptoms of migraine headaches (severe, throbbing headaches that sometimes are accompanied by other symptoms such as nausea and sensitivity to sound and light). Zolmitriptan is in a class of medications called selective serotonin (5-HT) receptor agonists. It works by narrowing blood vessels around the brain and stopping the release of certain natural substances that cause pain, nausea, and other symptoms of migraine. Zolmitriptan does not prevent migraine attacks.

# How should this medicine be used
Zolmitriptan comes as a spray to inhale through the nose. It is usually used during a migraine attack. If your symptoms improve after you use zolmitriptan but return after 2 hours or longer, you may use a second dose of zolmitriptan. However, if your symptoms do not improve after you use zolmitriptan, do not use a second dose without talking to your doctor. Do not use more than two sprays of zolmitriptan in a 24-hour period. Call your doctor if you need to use zolmitriptan nasal spray to treat more than four headaches in 1 month. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use zolmitriptan exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
Do not use zolmitriptan to treat a headache that feels different than your usual migraine attacks. Call your doctor to find out what you should do.
If you have certain risk factors for heart disease, your doctor may ask you to use your first dose of zolmitriptan in the doctor's office or other medical facility where you can be monitored for serious reactions.
Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.
To use the nasal spray, follow these steps:
- Read all of the manufacturer's instructions for using the nasal spray before you use your first dose.
- Blow your nose gently.
- Remove the protective cap from the sprayer.
- Hold the sprayer between your fingers and thumb, but be careful not to press the plunger.
- Use your other hand to block one nostril by pressing firmly on the side of your nose.
- Put the tip of the sprayer into your other nostril as far as feels comfortable and tilt your head back slightly. Be careful not to press the plunger or spray the medication in your eyes.
- Breathe in gently through your nose. At the same time, press the plunger firmly with your thumb. The plunger may feel stiff and you may hear a click.
- Keep your head slightly tilted back and remove the tip from your nose.
- Breathe gently through your mouth for 5-10 seconds. It is normal to feel liquid in your nose or the back of your throat.
- The sprayer only contains one dose of medication. After you have used it, throw it away in a trash can that is out of the reach of children and pets.

# Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

# What special precautions should I follow
Before using zolmitriptan
- tell your doctor and pharmacist if you are allergic to zolmitriptan or any other medications.
- do not use zolmitriptan if you have taken any of the following medications in the past 24 hours: other selective serotonin receptor agonists such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), or sumatriptan (Imitrex); or ergot-type medications such as bromocriptine (Parlodel), cabergoline (Dostinex), dihydroergotamine (D.H.E. 45, Migranal), ergoloid mesylates (Germinal, Hydergine), ergonovine (Ergotrate), ergotamine (Bellergal-S, Cafergot, Ergomar, Wigraine), methylergonovine (Methergine), methysergide (Sansert), and pergolide (Permax).
- do not use zolmitriptan if you are taking a monoamine oxidase A (MAO-A) inhibitor such as isocarboxazid (Marplan), phenelzine (Parnate), or tranylcypromine (Nardil) or if you have taken one of these medications in the past 2 weeks.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: acetaminophen (Tylenol); cimetidine (Tagamet); oral contraceptives ('birth control pills'); propranolol (Inderal); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine , paroxetine (Paxil), and sertraline (Zoloft); and selective serotonin/norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) and venlafaxine (Effexor). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you smoke, if you or any family members have or have ever had heart disease, if you have gone through menopause (change of life), and if you have or have ever had a heart attack; angina (chest pain); pounding or irregular heartbeat; shortness of breath; a stroke or 'mini-stroke'; high blood pressure; high cholesterol; diabetes; seizures; circulation problems such as varicose veins, blood clots in the legs, Raynaud's disease (problems with blood flow to the fingers, toes, ears, and nose) or ischemic bowel disease (bloody diarrhea and stomach pain caused by decreased blood flow to the intestines);or liver or kidney disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you plan to be sexually active while you are using this medication, talk to your doctor about effective methods of birth control. If you become pregnant while taking zolmitriptan, call your doctor.
- you should know that zolmitriptan may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
- talk to your doctor about your headache symptoms. Zolmitriptan should not be used to treat certain types of migraine headaches (hemiplegic or basilar) or other types of headaches (such as cluster headaches).

# What special dietary instructions should I follow
Unless your doctor tells you otherwise, continue your normal diet.

# Side Effects

## Mild side effects
Zolmitriptan may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- sore or irritated nose
- sensitive skin, especially around the nose
- dry mouth
- unusual taste in the mouth
- upset stomach
- dizziness
- weakness
- burning or tingling feeling

## Severe side effects
Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:
- pain, tightness, pressure, or heaviness in the chest, throat, or jaw
- slow or difficult speech
- dizziness or faintness
- problems with vision
- weakness or numbness of an arm or leg
- fast, pounding, or irregular heartbeat
- bloody diarrhea
- stomach pain
- paleness or blue color of the fingers and toes
- shortness of breath
- swelling of the eyes, face, lips, tongue, or throat
- difficulty swallowing
- hoarseness
Zolmitriptan may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

# What storage conditions are needed for this medicine
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include:
- sleepy, quiet state

# What other information should I know
Keep all appointments with your doctor.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Zomig