Zolmitriptan Nasal Spray

WHY is this medicine prescribed?

Zolmitriptan nasal spray 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 receptor agonists. It works by narrowing blood vessels around the brain, stopping pain signals from being sent to the brain, and blocking the release of certain natural substances that cause pain, nausea, and other symptoms of migraine. Zolmitriptan does not prevent migraine attacks or reduce the number of headaches you have.

HOW should this medicine be used?

Zolmitriptan comes as a spray to inhale through the nose. It is usually used at the first sign of a migraine headache. 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. 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.

You may use your first dose of zolmitriptan nasal spray in a doctor's office or other medical facility where you can be monitored for serious reactions.

Call your doctor if your headaches do not get better or occur more frequently after using zolmitriptan nasal spray.

If you use zolmitriptan more often or for longer than the recommended period of time, your headaches may get worse or may occur more frequently. You should not use zolmitriptan nasal spray or take any other headache medication for more than 10 days per month. Call your doctor if you need to use zolmitriptan nasal spray to treat more than three headaches in a 1-month period.

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, dispose of it in a trash can that is out of the reach of children and pets.

Are there 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 nasal spray,

• tell your doctor and pharmacist if you are allergic to zolmitriptan, any other medications, or any of the ingredients in zolmitriptan nasal spray. Ask your pharmacist for a list of the ingredients.
• do not use zolmitriptan nasal spray 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, in Treximet); or ergot-type medications such as bromocriptine (Parlodel), cabergoline, dihydroergotamine (D.H.E. 45, Migranal), ergoloid mesylates (Hydergine), ergonovine (Ergotrate), ergotamine (Cafergot, Ergomar, Wigraine), methylergonovine (Methergine), methysergide (Sansert), and pergolide (Permax).
• tell your doctor or pharmacist if you are taking the following medications or have stopped taking them within the past two weeks: monoamine oxidase A (MAO-A) inhibitor such as isocarboxazid (Marplan), phenelzine (Parnate), or tranylcypromine (Nardil)..
• some medications should not be taken with zolmitriptan nasal spray. Other medications may cause dosing changes or extra monitoring when taken with zolmitriptan nasal spray. Make sure you have discussed any medications you are currently taking or plan to take before starting zolmitriptan nasal spray with your doctor and pharmacist. Before starting, stopping, or changing any medications while taking zolmitriptan nasal spray, please get the advice of your doctor or pharmacist.
• the following nonprescription products may interact with zolmitriptan nasal spray: cimetidine (Tagamet); acetaminophen (Tylenol); aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). Be sure to let your doctor and pharmacist know that you are taking these medications before you start using zolmitriptan nasal spray. Do not start any of these medications while using zolmitriptan nasal spray without discussing with your healthcare provider.
• tell your doctor if you have or have ever had heart disease; a heart attack; angina (chest pain); irregular heartbeats; stroke or 'mini-stroke'; or 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). Your doctor may tell you not to use zolmitriptan nasal spray.
• tell your doctor if you smoke or are overweight; if you have or have ever had high blood pressure, high cholesterol, diabetes, or liver or kidney disease;if you have gone through menopause (change of life); or if any family members have or have ever had heart disease or stroke.
• 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 using zolmitriptan nasal spray, call your doctor.
• you should know that zolmitriptan nasal spray 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 to make sure they are caused by migraine. Zolmitriptan nasal spray 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.

What SIDE EFFECTS can this medicine cause?

Zolmitriptan nasal spray 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
• nausea
• tiredness
• dizziness
• weakness
• burning or tingling feeling

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment:

• pain, tightness, pressure, or heaviness in the chest, throat, neck, or jaw
• slow or difficult speech
• faintness
• breaking out in a cold sweat
• problems with vision
• weakness or numbness of an arm or leg
• fast, pounding, or irregular heartbeat
• bloody diarrhea
• vomiting
• sudden or severe stomach pain
• sudden weight loss
• paleness or blue color of the fingers and toes
• shortness of breath
• swelling of the eyes, face, lips, tongue, or throat
• difficulty breathing or swallowing
• rash
• hives
• hoarseness
• pain, burning, or tingling in the hands or feet

Zolmitriptan nasal spray may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

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).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include:

• extreme drowsiness

What OTHER INFORMATION should I know?

Keep all appointments with your doctor. Your blood pressure should be checked regularly.

You should keep a headache diary by writing down when you have headaches and when you use zolmitriptan nasal spray.

Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. represents that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS^® Patient Medication Information™. © Copyright, 2024. The American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Selected Revisions: February 15, 2018.