Zolmist Nasal Spray (Zolmitriptan 5mg)

Zolmist general information

What is Zolmist used for?

Zolmist nasal spray 5mg used for acute treatment of migraine, where there is a clear diagnosis of migraine, to relieve acute migraine attacks with or without aura, which is the perception of visual disturbances and/or smells and are usually the first sign that a migraine headache is on its way.  Zolmist nasal spray should only be used for treatment of a migraine attack to relieve headache and other symptoms, including nausea and sensitivity to light, but should not be used as prophylaxis to prevent migraine headaches from occurring.  Zolmist nasal spray 5mg is not intended for the treatment of other types of headache, such as cluster headache, which is a very painful type of headache that occurs in regular cycles or clusters, interspersed with periods of remission.  Zolmist nasal spray is not intended for the management of haemiplegic migraine, which can also cause temporary weakness of one side of the body and paralysis; or basilar migraine, which is another form of migraine and is caused by an arterial spasm at the base of the brain restricting blood flow to the brain.

How does Zolmist work?

Zolmist nasal spray 5mg contain zolmitriptan, which is a member of the group of drugs called tryptans and is a serotonin agonist that mimics the action of serotonin (also known as 5-hydroxytryptamine, or 5-HT).  Serotonin is a brain chemical that is involved in control of mood, pain sensation, sexual behaviour, sleep, as well as dilation (widening) and constriction (narrowing) of blood vessels.  Migraine is an intense, throbbing painful headache that usually affects one side of the head and is thought to be caused by the dilatation or widening of the blood vessels in the brain due to one of many migraine triggers.  This in turn stimulates nearby sensory nerves of the trigeminal system to release neuropeptides or brain chemicals that cause you to feel pain and induce inflammation.  Zolmitriptan in Zolmist nasal spray 5mg binds specifically to the 5-HT_1B and 5-HT _1D receptors in these expanded blood vessels of the brain and stimulates the receptors, which causes vasoconstriction or narrowing of blood vessels, returning them to their original normal size.  Zolmitriptan in Zolmist nasal spray 5mg also binds to 5-HT _1D receptors on the nerve cells of the trigeminal system and inhibits the release of neuropeptides from the activated nerves, reducing the transmission of pain messages, which helps relieve pain and inflammation, as well as other symptoms of migraine headache, such as nausea and sensitivity to light and sound.  Both actions are thought to contribute to the anti-migraine action of zolmitriptan and relieve headache and other symptoms of a migraine attack.  Zolmitriptan in Zolmist nasal spray provides rapid onset of relief of migraine as it is rapidly absorbed through the mucous membrane of the nasal passages following intranasal administration, and is effective faster than oral administration, with a significant effect within 15 minutes of using.  Zolmist nasal spray is also helpful if nausea and vomiting make it difficult to swallow tablets. 

What does Zolmist contain?

Zolmist nasal spray contains the active ingredient zolmitriptan 5mg/ml in aqueous solution, a serotonin agonist that is used to treat migraine attack.  Each bottle of Zolmist nasal spray contains 7 doses in 0.7ml and each dose of 5mg/0.1ml is delivered through a metered-dose spray pump unit. 

Treating migraine with Zolmist

Zolmist nasal spray 5mg contain zolmitriptan that is used to treat migraine attack with or without aura, which is the perception of visual disturbances and/or smells and are usually the first sign that a migraine headache is on its way.  Zolmist nasal spray 5mg is a serotonin agonist that mimics the action of serotonin (also known as 5-hydroxytryptamine, or 5-HT) by binding specifically to serotonin receptors in the blood vessels of the brain.  Migraine is an intense, throbbing painful headache that usually affects one side of the head and is thought to be caused by the dilatation or widening of the blood vessels in the brain due to one of many migraine triggers.  This in turn stimulates nearby sensory nerves of the trigeminal system to release neuropeptides or brain chemicals that cause you to feel pain and induce inflammation.  Zolmitriptan in Zolmist nasal spray stimulates the serotonin receptors in these expanded blood vessels making them narrow again (vasoconstriction) and inhibits trigeminal nerve activity, relieving pain.  Both actions are thought to contribute to the anti-migraine action of zolmitriptan in Zolmist nasal spray to relieve headache and other symptoms of a migraine attack including nausea and sensitivity to light. 

What are the side effects of Zolmist?

The most commonly reported side effects when taking Zolmist nasal spray 5mg include, disorder/discomfort of nasal cavity, tightness of the throat, unusual taste, dry mouth, nausea, paraesthesia (tingling, pricking, or numbness of the skin), dizziness, somnolence, asthenia (loss of strength), headache.

When should Zolmist not be used?

You should not use Zolmist nasal spray 5mg if you:

• are allergic to zolmitriptan or any ingredients in Zolmist
• are pregnant or are breastfeeding
• have kidney or liver disease
• have uncontrolled high blood pressure
• have ischaemic heart disease or history of heart disease, including angina, stroke, heart attack
• have peripheral vascular disease 
• have hemiplegic or basilar migraine, which are rare and more serious forms of migraine
• are currently taking monoamine oxidase (MAO) inhibitors or have taken any within 2 weeks
• are currently taking another migraine medication including another 5-HT agonist such as sumatriptan or ergot derivatives like methysergide
• are taking medicines that interact with Zolmist including beta blockers like propranolol for hypertension, SSRIs (like fluoxetine) or SNRI (like venlafaxine) for depression, cimetidine for reflux

What medications interact with Zolmist?

Several medications interact with Zolmist nasal spray 5mg and should either not be taken while you are taking Zolmist or only after discussion and instruction from your doctor:

• Drugs that cause a serious reaction with Zolmist: SSRIs (like fluoxetine) or SNRI (like venlafaxine) for depression
• Drugs that affect Zolmist: monoamine oxidase (MAO) inhibitors for depression, beta blockers like propranolol for hypertension
• Drugs that are affected by Zolmist: cimetidine for reflux

How should Zolmist be taken?

You can use Zolmist nasal spray 5mg at any stage of a migraine attack but it is more effective if taken as soon as possible after the first signs of headache and/or aura.  You should take one spray of Zolmist nasal spray 5mg into one nostril and should feel relief from symptoms within 15 minutes, but you can repeat with another spray if the headache returns after two hours.  You can take another dose if you have another migraine attack in the next 24 hours, provided you do not take more than 10mg in a 24 hour period. 

How should Zolmist be stored?

You should store your Zolmist below 25°C in a cool dry place.