Zolmitriptan

In this section
Does it work?
What is it?
How can it help?
Why should it work?
Can it be harmful?
What's the evidence?

Does it work?

Yes. Zolmitriptan should make your migraine attack better. If your attack is severe, it may make it more bearable. It may also help with other symptoms, including nausea, vomiting and feeling extra-sensitive to lights or sounds.

Studies show that zolmitriptan seems to work as well as another similar drug called sumatriptan.

What is it?

Zolmitriptan is a type of drug known as a triptan. It works in a similar way to a chemical in your brain called serotonin. Like serotonin, zolmitriptan makes the blood vessels in your brain narrower. And this can stop the pain of migraine, at least partly.

The brand name for zolmitriptan is Zomig. It comes as tablets, as a nasal spray, and also as wafers or special tablets that dissolve when you put them in your mouth.

How can it help?

Zolmitriptan can make migraine headaches better within two hours.^{1 2 3}

• After using zolmitriptan, 6 in 10 people find that their migraine pain is mild or has gone away completely.¹
• You should be able to get back to your usual routine after using this drug.
• Taking zolmitriptan also makes it less likely that you will need to take other painkillers. (One-third of people who take this drug will need to take more medicine compared to two-thirds who don't take anything).
• Zolmitriptan helps with other symptoms of migraine attacks, including nausea and being unable to bear light and noise.³
• A zolmitriptan pill that dissolves on the tongue works well for many people.³
• Some evidence says that zolmitriptan seems to work as well as sumatriptan, aspirin and naratriptan.^{1 4 5}

Zolmitriptan is often given in doses of 2.5 milligrams (mg) or 5 mg. Research has shown that both doses work well.¹

A study looking at all the triptans available at the time (in 2007) found that they all helped to get rid of the pain within two hours, or make it much milder, compared to a dummy drug (placebo). But only sumatriptan and rizatriptan worked better than a placebo drug within half an hour.⁶

Why should it work?

Like other triptans, zolmitriptan acts like a chemical in your brain called serotonin. It binds to your cells at specific sites called serotonin receptors, rather like a key being put into a lock.

Zolmitriptan helps to treat migraine in three main ways.

• When you have an attack, the blood vessels in your brain open up (dilate). This means there is more blood flowing through them. Researchers think this is what causes the pain when you have a migraine. Zolmitriptan corrects the changes in blood flow and makes the blood vessels narrower.
• Secondly, it blocks nerves from releasing chemicals that cause blood vessels in your brain to open up.
• Thirdly, it blocks the release of chemicals that carry pain messages between different parts of your brain.

All of these effects work together to help you feel better.

Can it be harmful?

Like all triptan drugs, zolmitriptan can have side effects although they are usually mild and do not last long.¹

• The most common side effects are pins and needles and feelings of warmth in different parts of the body.
• This medicine can also make you feel dizzy or flushed or get neck pain and stiffness.
• You can get more worrying side effects like feeling confused and drowsy but these are less common.
• Some people get chest pain or tightness but this is not very common.

The higher the dose of zolmitriptan you take, the more likely you are to get more serious side effects.

It's not clear from the research what proportion of people get side effects. Different studies say different things. And in many studies, people taking a dummy treatment for comparison (a placebo) also got side effects. So it may not always be zolmitriptan that is causing the side effects.

Here are the side effects that have been reported by people taking zolmitriptan in studies.

• Feeling weak (asthenia): 7 in 100 people who took 5 mg of zolmitriptan got this.²
• Loss of sensation: 7 in 100 people who took 5 mg got this.²
• Pain in the abdomen: 7 in 100 people who took 5 mg got this.²
• Feeling tightness in the throat: Between 2 in 100 and 3 in 100 people who took 2.5 mg got this.³
• Feeling drowsy: 3 in 100 people who took 2.5 mg felt this.³

The good news is that not many people seem to stop taking zolmitriptan because of side effects. In one study, less than 1 in 100 people taking zolmitriptan withdrew because of the side effects.⁷

If you have heart disease, you should not take this medicine. It can make your blood vessels narrower and your heart disease worse. If you have risk factors for heart disease, like high blood pressure, your doctor might want you to take some heart tests before using this medicine to see if it is safe for you.⁸

Triptans and antidepressants

If you take zolmitriptan (or any other triptan) together with one of the groups of medicines called selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-noradrenaline reuptake inhibitors (SNRIs), there's a chance you could get a condition called serotonin syndrome.⁹ SSRIs and SNRIs are types of antidepressants. They are treatments for depression and some other mental health problems. SNRIs are sometimes called selective serotonin-norepinephrine reuptake inhibitors.

Serotonin syndrome happens when you get too much serotonin in your body. It can be fatal. All SSRIs and SNRIs increase the amount of serotonin in the body. Names (and brand names) of SSRIs and SNRIs include:

• citalopram (Cipramil)
• duloxetine (Cymbalta)
• escitalopram (Cipralex)
• fluovoxamine (Faverin)
• fluoxetine (Prozac)
• paroxetine (Seroxat)
• sertraline (Lustral)
• venlafaxine (Effexor).

The symptoms of serotonin syndrome are:

• Feeling restless
• Rapid changes in blood pressure (you may not notice anything when this happens)
• A rise in your body temperature
• Feeling jittery
• Feeling like you might be sick
• Vomiting
• Diarrhoea.

The chances of getting serotonin syndrome are highest when you start treatment with one of these medicines in addition to one you're already taking, or the dose of one of them is increased.

If you get any of the above symptoms you should see your doctor or go to an emergency department straight away.

What's the evidence?

What's the evidence for zolmitriptan?