Zolmitriptan Dosage

Usual Adult Dose for Migraine

Zolmitriptan should only be used when a clear diagnosis of migraine has been established.

2.5 mg orally once or 5 mg intranasally once
May repeat dose after 2 hours.
Maximum dose in a 24 hour period is 10 mg.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

The initial dose recommended for use in patients with hepatic dysfunction is 1.25 mg orally once.

Significant elevations in blood pressure have been reported in some patients with moderate to severe liver dysfunction. Therefore, both a lower dose and blood pressure monitoring are recommended for patients with liver dysfunction.

Dose Adjustments

The manufacturer reports that in the only direct comparison of 2.5 and 5 mg doses, there was little added benefit from the larger dose, but side effects were generally increased at 5 mg.

The safety of treating an average of more than 3 headaches in a 30 day period has not been established.

Precautions

Zolmitriptan should not be prescribed for patients with ischemic heart disease (angina pectoris, history of myocardial infarction, or documented silent ischemia) or to patients who have symptoms or findings consistent with ischemic heart disease, coronary artery vasospasm, including Prinzmetal's angina, or other significant underlying cardiovascular disease.

The manufacturer strongly recommends that zolmitriptan not be prescribed to patients in whom unrecognized coronary artery disease (CAD) is predicted by the presence of risk factors (e.g. hypertension, hypercholesterolemia, smoker, obesity, diabetes, a strong family history of CAD, female with surgical or physiological menopause, or male over 40 years old) unless a cardiovascular evaluation provides satisfactory clinical evidence that the patient is reasonably free of coronary artery and ischemic myocardial disease or other significant underlying cardiovascular disease.

For patients with risk factors predicative of CAD, who are determined to have a satisfactory cardiovascular evaluation, the manufacturer strongly recommends that the administration of the first dose take place in a physician's office or a similarly medically staffed and equipped facility. Because, cardiac ischemia may occur in the absence of clinical symptoms, use of an electrocardiogram during the interval immediately following the administration of the first dose may also be appropriate.

The manufacturer recommends that patients receiving intermittent long-term therapy who have or acquire risk factors predictive of CAD (described above) undergo cardiovascular evaluations at periodic intervals.

Patients with symptomatic Wolff-Parkinson-White syndrome or arrhythmias associated with other cardiac accessory conduction pathway disorders should not receive zolmitriptan.

Dialysis

Data not available

Other Comments

Some of the commercial preparations may contain phenylalanine.

See also...