Zolmitriptan

WHY is this medicine prescribed?

Zolmitriptan is used to treat the symptoms of migraine headaches (severe throbbing headaches that sometimes are accompanied by 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.

Are there OTHER USES for this medicine?

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

HOW should this medicine be used?

Zolmitriptan comes as a tablet and an orally disintegrating tablet (tablet that dissolves quickly in the mouth) to take by mouth. It is usually taken at the first sign of a migraine headache. If your symptoms improve after you take zolmitriptan but return after 2 hours or longer, you may take a second tablet. However, if your symptoms do not improve after you take zolmitriptan, do not take a second tablet without calling your doctor. Your doctor will tell you the maximum number of tablets or orally disintegrating tablets you may take in a 24-hour period. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take zolmitriptan exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

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

If your doctor has prescribed a dose lower than 2.5 mg, you may use your fingers to break the 2.5-mg tablet on the line that divides it in half. However, you should not break or split the orally disintegrating tablet.

To take the orally disintegrating tablet, use dry hands to peel back the foil packaging. Immediately take out the tablet and place it on your tongue. The tablet will quickly dissolve and can be swallowed with saliva. No water is needed to swallow disintegrating tablets. Do not open the foil packaging or remove the orally disintegrating tablet until just before you are ready to take it.

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

If you take 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 take zolmitriptan or any other headache medication for more than 10 days per month. Call your doctor if you need to take zolmitriptan 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.

What SPECIAL PRECAUTIONS should I follow?

Before taking zolmitriptan,

• tell your doctor and pharmacist if you are allergic to zolmitriptan, any other medications, or any of the ingredients in zolmitriptan tablets or orally disintegrating tablets. Ask your pharmacist for a list of the ingredients.

• do not take 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, 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).

• do not take 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.

• some medications should not be taken with zolmitriptan. Other medications may cause dosing changes or extra monitoring when taken with zolmitriptan. Make sure you have discussed any medications you are currently taking or plan to take before starting zolmitriptan with your doctor and pharmacist. Before starting, stopping, or changing any medications while taking zolmitriptan, please get the advice of your doctor or pharmacist.

• the following nonprescription product may interact with zolmitriptan: cimetidine. Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking zolmitriptan. Do not start any of these medications while taking zolmitriptan 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 take zolmitriptan.

• 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 taking 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 this medication may make you drowsy or dizzy. Do not drive a car or operate machinery until you know how zolmitriptan affects you.

• talk to your doctor about your headache symptoms to make sure they are caused by migraine. Zolmitriptan should not be used to treat certain types of migraine headaches (hemiplegic or basilar) or other types of headaches (such as cluster headaches).

• if you have phenylketonuria (PKU, an inherited condition in which a special diet must be followed to prevent damage to your brain that can cause severe intellectual disability), you should know that the orally disintegrating tablets contain aspartame that forms phenylalanine.

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 may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• feeling warm or cold
• drowsiness
• dry mouth
• nausea
• heartburn
• sweating
• dizziness or faintness

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
• weakness or numbness of an arm or leg
• fast, pounding, or irregular heartbeat
• bloody diarrhea
• sudden or severe stomach pain
• 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
• hoarseness
• rash
• hives
• pain, burning, or tingling in the hands or feet

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 (http://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 light, excess heat, and moisture (not in the bathroom). Dispose of any orally disintegrating tablets that you removed from the blister pack but did not use immediately.

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 (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

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. http://www.upandaway.org

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 take zolmitriptan.

Do not let anyone else take 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.