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Zolmitriptan Disease Interactions

There are 4 disease interactions with zolmitriptan:

Major

5-Ht1 Agonists (Includes Zolmitriptan) ↔ Cad Risk Factors

Severe Potential Hazard, High plausibility

Applies to: Diabetes Mellitus, History (Familial) - Ischemic Heart Disease, Hyperlipidemia, Menopausal Disorders, Obesity, Smoking

The group of drugs known as 5-hydroxytryptamine1 receptor (5-HT1) agonists can cause vasospastic reactions, including coronary vasospasm, peripheral vascular ischemia, and colonic ischemia. Rarely, serious adverse cardiac events including acute myocardial infarction, arrhythmia, cardiac arrest, and death have been reported within a few hours following the administration of 5-HT1 agonists, in some cases even in patients with no prior history or findings of coronary artery disease (CAD). Significant elevation in blood pressure, including hypertensive crisis, has also been reported on rare occasions in patients with and without a history of hypertension, as have transient increases in blood pressure and peripheral vascular resistance. In general, patients with potentially unrecognized CAD as predicted by the presence of risk factors (e.g., hypertension, hypercholesterolemia, tobacco use, obesity, diabetes, strong family history of CAD, female with surgical or physiological menopause, or male over 40 years of age) should not be administered 5-HT1 agonists unless a cardiovascular evaluation provides satisfactory clinical evidence indicating the lack of CAD, ischemic heart disease, or other significant underlying cardiovascular disease. As a precaution, the manufacturers recommend that the first dose be administered under medical surveillance in such patients, and that electrocardiographic monitoring be considered during the interval immediately following administration to help detect any asymptomatic cardiac ischemia that may occur. Periodic cardiovascular evaluations should be performed during intermittent, long-term use.

References

  1. Mueller L, Gallagher RM, Ciervo CA "Vasospasm-induced myocardial infarction with sumatriptan." Headache 36 (1996): 329-31
  2. Kelly KM "Cardiac arrest following use of sumatriptan." Neurology 45 (1995): 1211-3
  3. "Product Information. Axert (almotriptan)" Pharmacia and Upjohn, Kalamazoo, MI.
View all 23 references
Major

5-Ht1 Agonists (Includes Zolmitriptan) ↔ Cardiovascular Disease

Severe Potential Hazard, High plausibility

Applies to: History - Myocardial Infarction, Cardiovascular Disease, Cerebral Vascular Disorder, History - Cerebrovascular Disease

The use of 5-hydroxytryptamine1 receptor (5-HT1) agonists is contraindicated in patients with a current or past history of ischemic cardiac, cerebrovascular, and/or peripheral vascular diseases. In addition, these agents should not be used in patients with significant underlying cardiovascular diseases or uncontrolled hypertension. 5-HT1 agonists can cause vasospastic reactions, including coronary vasospasm, peripheral vascular ischemia, and colonic ischemia. Rarely, serious adverse cardiac events including acute myocardial infarction, arrhythmia, cardiac arrest, and death have been reported within a few hours following the administration of 5-HT1 agonists, in some cases even in patients with no prior history or findings of coronary artery disease (CAD). Significant elevation in blood pressure, including hypertensive crisis, has also been reported on rare occasions in patients with and without a history of hypertension, as have transient increases in blood pressure and peripheral vascular resistance. Cerebrovascular events have included cerebral hemorrhage, subarachnoid hemorrhage, and stroke, some resulting in fatalities. However, the relationship to 5-HT1 agonists is uncertain and, in a number of cases, the cerebrovascular events may have been primary where symptoms were mistaken to be migraine.

References

  1. Ottervanger JP, Paalman HJ, Boxma GL, Stricker BH "Transmural myocardial infarction with sumatriptan." Lancet 341 (1993): 861-2
  2. Kelly KM "Cardiac arrest following use of sumatriptan." Neurology 45 (1995): 1211-3
  3. "Product Information. Axert (almotriptan)" Pharmacia and Upjohn, Kalamazoo, MI.
View all 23 references
Major

Zolmitriptan (Includes Zolmitriptan) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Zolmitriptan is primarily metabolized by the liver. Following oral administration in patients with severe hepatic impairment, plasma concentrations of zolmitriptan were significantly increased (up to several-fold) compared to healthy controls. Some patients experienced 20 to 80 mm Hg elevations in systolic and/or diastolic blood pressure after a 10 mg dose, presumably due to drug accumulation. Therapy with zolmitriptan should be administered cautiously in patients with impaired hepatic function. Lower dosages, no more than 2.5 mg, as well as blood pressure monitoring should be considered in patients with moderate or severe hepatic impairment.

References

  1. "Product Information. Zomig (zolmitriptan)." Zeneca Pharmaceuticals, Wilmington, DE.
Moderate

Zolmitriptan (Includes Zolmitriptan) ↔ Renal Dysfunction

Moderate Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Zolmitriptan is excreted in the urine primarily as metabolites but also as unchanged drug. Following oral administration in patients with renal impairment, the clearance of zolmitriptan was not significantly altered in patients with moderate impairment (CrCl = 26 to 50 mL/min) but was reduced by 25% in patients with severe impairment (CrCl = 5 to 25 mL/min) compared to healthy controls. Therapy with rizatriptan should be administered cautiously in patients with significantly impaired renal function. A lower initial dosage may be appropriate.

References

  1. "Product Information. Zomig (zolmitriptan)." Zeneca Pharmaceuticals, Wilmington, DE.

zolmitriptan drug Interactions

There are 121 drug interactions with zolmitriptan

zolmitriptan alcohol/food Interactions

There are 3 alcohol/food interactions with zolmitriptan

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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