Symptoms
Volunteers receiving single oral doses of 50 mg commonly experienced sedation.
Management
The elimination half-life of zolmitriptan is 2.5 to 3 hours, and therefore monitoring of patients after overdose with Zolmitriptan Zentiva Rapimelt should continue for at least 15 hours or while symptoms or signs persist.
There is no specific antidote to zolmitriptan. In cases of severe intoxication, intensive care procedures are recommended, including establishing and maintaining a patent airway, ensuring adequate oxygenation and ventilation, and monitoring and support of the cardiovascular system.
It is unknown what effect haemodialysis or peritoneal dialysis has on the serum concentrations of zolmitriptan.
Symptoms
Volunteers receiving single oral doses of 50 mg commonly experienced sedation.
Management
The elimination half-life of zolmitriptan is 2.5 to 3 hours, and therefore monitoring of patients after overdose with Zolmitriptan Zentiva should continue for at least 15 hours or while symptoms or signs persist.
There is no specific antidote to zolmitriptan. In cases of severe intoxication, intensive care procedures are recommended, including establishing and maintaining a patent airway, ensuring adequate oxygenation and ventilation, and monitoring and support of the cardiovascular system.
It is unknown what effect haemodialysis or peritoneal dialysis has on the serum concentrations of zolmitriptan.
Volunteers receiving single oral doses of 50 mg commonly experienced sedation.
The elimination half-life of Zolmitriptan Zentiva is 2.5 to 3 hours, and therefore monitoring of patients after overdose with Zolmitriptan Zentiva should continue for at least 15 hours or while symptoms or signs persist.
There is no specific antidote to Zolmitriptan Zentiva. In cases of severe intoxication, intensive care procedures are recommended, including establishing and maintaining a patent airway, ensuring adequate oxygenation and ventilation, and monitoring and support of the cardiovascular system.
It is unknown what effect haemodialysis or peritoneal dialysis has on the serum concentrations of Zolmitriptan Zentiva.
-
- Uncontrolled hypertension.
- Ischaemic heart disease.
- Coronary vasospasm/Prinzmetal's angina.
- A history of cerebrovascular accident (CVA) or transient ischaemic attack (TIA)
- Concomitant administration of Zolmitriptan Zentiva with ergotamine or ergotamine derivatives or other 5-HT1 receptor agonists.
-
- Uncontrolled hypertension.
- Ischaemic heart disease.
- Coronary vasospasm/Prinzmetal's angina.
- A history of cerebrovascular accident (CVA) or transient ischaemic attack (TIA)
- Concomitant administration of Zomig with ergotamine or ergotamine derivatives or other 5-HT1 receptor agonists.
.Moderate or severe hypertension, and mild uncontrolled hypertension.
This class of compounds (5HT1B/1D receptor agonists), has been associated with coronary vasospasm, as a result, patients with ischaemic heart disease were excluded from clinical trials. Therefore Zolmitriptan Zentiva should not be given to patients who have had myocardial infarction or have ischaemic heart disease, coronary vasospasm (Prinzmetal's angina), peripheral vascular disease or patients who have symptoms or signs consistent with ischaemic heart disease.
Concurrent administration of ergotamine, derivatives of ergotamine (including methysergide), sumatriptan, naratriptan and other 5HT1B/1D receptor agonists with Zolmitriptan Zentiva is contraindicated.
Zolmitriptan Zentiva should not be administered to patients with a history of cerebrovascular accident (CVA) or transient ischaemic attack (TIA).
Zolmitriptan Zentiva is contraindicated in patients with a creatinine clearance of less than 15 ml/min.
Not applicable.
Summary of the safety profile
Zolmitriptan Zentiva is well tolerated. Adverse reactions are typically mild/moderate, transient, not serious and resolve spontaneously without additional treatment.
Possible adverse reactions tend to occur within 4 hours of dosing and are no more frequent following repeated dosing.
Tabulated list of adverse reactions
Adverse reactions are classified according to frequency and system organ class. Frequency categories are defined according to the following convention: Very common (>1/10); Common (>1/100 to < 1/10); Uncommon (>1/1,000 to < 1/100); Rare (>1/10,000 to < 1/1,000); Very rare (<1/10,000); Not known (cannot be estimated from the available data). The following undesirable effects have been reported following administration with zolmitriptan:
| System Organ Class | Frequency | Undesirable Effect |
| Immune system disorders | Rare | Anaphylaxis/Anaphylactoid Reactions; Hypersensitivity reactions |
| Nervous system disorder | Common | Abnormalities or disturbances of sensation; Dizziness; Headache; Hyperaesthesia; Paraesthesia; Somnolence; Warm sensation. |
| Cardiac disorders | Common | Palpitations. |
| Uncommon | Tachycardia. | |
| Very rare | Angina pectoris; Coronary vasospasm; Myocardial infarction. | |
| Vascular disorders | Uncommon | Transient increases in systemic blood pressure. |
| Gastrointestinal disorders | Common | Abdominal pain; Dry mouth; Nausea; Vomiting; Dysphagia. |
| Very rare | Bloody diarrhoea; Gastrointestinal infarction or necrosis; Gastrointestinal ischaemic events; Ischaemic colitis; Splenic infarction. | |
| Skin and subcutaneous tissue disorders | Rare | Angioedema; Urticaria. |
| Musculoskeletal and connective tissue disorders | Common | Muscle weakness; Myalgia. |
| Renal and urinary disorders | Uncommon | Polyuria; Increased urinary frequency. |
| Very rare | Urinary urgency. | |
| General disorders and administration site conditions | Common | Asthenia; Heaviness, tightness, pain or pressure in throat, neck, limbs or chest. |
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme, Website: www.mhra.gov.uk/yellowcard.
Summary of the safety profile
Zomig is well tolerated. Adverse reactions are typically mild/moderate, transient, not serious and resolve spontaneously without additional treatment.
Possible adverse reactions tend to occur within 4 hours of dosing and are no more frequent following repeated dosing.
Tabulated list of adverse reactions
Adverse reactions are classified according to frequency and system organ class. Frequency categories are defined according to the following convention: Very common (>1/10); Common (>1/100 to < 1/10); Uncommon (>1/1,000 to < 1/100); Rare (>1/10,000 to < 1/1,000); Very rare (<1/10,000); Not known (cannot be estimated from the available data). The following undesirable effects have been reported following administration with zolmitriptan:
| System Organ Class | Frequency | Undesirable Effect |
| Immune system disorders | Rare | Anaphylaxis/Anaphylactoid Reactions; Hypersensitivity reactions |
| Nervous system disorder | Common | Abnormalities or disturbances of sensation; Dizziness; Headache; Hyperaesthesia; Paraesthesia; Somnolence; Warm sensation. |
| Cardiac disorders | Common | Palpitations. |
| Uncommon | Tachycardia. | |
| Very rare | Angina pectoris; Coronary vasospasm; Myocardial infarction. | |
| Vascular disorders | Uncommon | Transient increases in systemic blood pressure. |
| Gastrointestinal disorders | Common | Abdominal pain; Dry mouth; Nausea; Vomiting; Dysphagia. |
| Very rare | Bloody diarrhoea; Gastrointestinal infarction or necrosis; Gastrointestinal ischaemic events; Ischaemic colitis; Splenic infarction. | |
| Skin and subcutaneous tissue disorders | Rare | Angioedema; Urticaria. |
| Musculoskeletal and connective tissue disorders | Common | Muscle weakness; Myalgia. |
| Renal and urinary disorders | Uncommon | Polyuria; Increased urinary frequency. |
| Very rare | Urinary urgency. | |
| General disorders and administration site conditions | Common | Asthenia; Heaviness, tightness, pain or pressure in throat, neck, limbs or chest. |
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme, Website: www.mhra.gov.uk/yellowcard.
Possible undesirable effects are typically transient, tend to occur within four hours of dosing, are no more frequent following repeated dosing and resolve spontaneously without additional treatment.
The following definitions apply to the incidence of the undesirable effects:
Very common (>1/10); common (>1/100 to <1/10); uncommon (>1/1,000 to <1/100), rare (>1/10,000 to <1/1,000), very rare (<1/10,000).
Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness.
The following undesirable effects have been reported following administration of Zolmitriptan Zentiva:
| System Organ Class | Frequency | Undesirable Effect |
| Immune system disorders | Rare | Hypersensitivity reactions including urticaria, angioedema and anaphylactic reactions |
| Nervous system disorders | Common | Abnormalities or disturbances or sensation; Dizziness; Headache; Hyperaesthesia; Paraesthesia; Somnolence; Warm sensation |
| Cardiac disorders | Common | Palpitations |
| Uncommon | Tachycardia | |
| Very rare | Myocardial infarction; Angina pectoris; Coronary vasospasm | |
| Vascular disorders | Uncommon | Slight increases in blood pressure; Transient increases in systemic blood pressure |
| Gastrointestinal disorders | Common | Abdominal pain; Nausea; Vomiting; Dry mouth Dysphagia |
| Very rare | Ischaemia or infarction (e.g. intestinal ischaemia, intestinal infarction, splenic infarction) which may present as bloody diarrhoea or abdominal pain | |
| Musculoskeletal and connective tissue disorders | Common | Muscle weakness; Myalgia |
| Renal and urinary disorders | Uncommon | Polyuria; Increased urinary frequency |
| Very rare | Urinary urgency | |
| General disorders and administration site conditions | Common | Asthenia; Heaviness, tightness, pain or pressure in throat, neck, limbs or chest. |
Certain symptoms, may be part of the migraine attack itself.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard
An oral teratology study of zolmitriptan has been conducted. At the maximum tolerated doses, 1200 mg/kg/day (AUC 605 μg/ml.h : approx. 3700 x AUC of the human maximum recommended daily intake of 15 mg) and 30 mg/kg/day (AUC 4.9 μg/ml.h: approx. 30 x AUC of the human maximum recommended daily intake of 15 mg) in rats and rabbits, respectively, no signs of teratogenicity were apparent.
Five genotoxicity tests have been performed. It was concluded that Zolmitriptan Zentiva Rapimelt is not likely to pose any genetic risk in humans.
Carcinogenicity studies in rats and mice were conducted at the highest feasible doses and gave no suggestion of tumorogenicity.
Reproductive studies in male and female rats, at dose levels limited by toxicity, revealed no effect on fertility.
An oral teratology study of zolmitriptan has been conducted. At the maximum tolerated doses, 1200 mg/kg/day (AUC 605 μg/ml.h : approx. 3700 x AUC of the human maximum recommended daily intake of 15 mg) and 30 mg/kg/day (AUC 4.9 μg/ml.h: approx. 30 x AUC of the human maximum recommended daily intake of 15 mg) in rats and rabbits, respectively, no signs of teratogenicity were apparent.
Five genotoxicity tests have been performed. It was concluded that Zolmitriptan Zentiva is not likely to pose any genetic risk in humans.
Carcinogenicity studies in rats and mice were conducted at the highest feasible doses and gave no suggestion of tumorogenicity.
Reproductive studies in male and female rats, at dose levels limited by toxicity, revealed no effect on fertility.
Preclinical effects in single and repeat dose toxicity studies were observed only at exposures well in excess of the maximum human exposure.
The findings from in vitro and in vivo genetic toxicity studies show that genotoxic effects of Zolmitriptan Zentiva are not to be expected under the conditions of clinical use.
No tumours relevant to the clinical use were found in mouse and rat carcinogenicity studies.
As with other 5HT1B/1D receptor agonists, Zolmitriptan Zentiva binds to melanin.
Zolmitriptan Zentiva Rapimelt is indicated for the acute treatment of migraine with or without aura.
Zolmitriptan Zentiva is indicated for the acute treatment of migraine with or without aura.
Acute treatment of migraine headache with or without aura.
Zolmitriptan Zentiva is not indicated for prophylaxis of migraine.
Pharmacotherapeutic group: Analgesics; antimigraine preparations; selective serotonin (5HT1) agonists, ATC code: N02CC03
Mechanism of action
Zolmitriptan Zentiva has been demonstrated to be a selective agonist for 5-HTIB/1D receptors mediating vascular contraction. Zolmitriptan Zentiva has high affinity for human recombinant 5-HTIB and 5-HTID receptors, and modest affinity for 5-HTIA receptors. Zolmitriptan Zentiva has no significant affinity or pharmacological activity at other 5-HT receptor subtypes (5-HT2, 5-HT3, 5-HT4) or adrenergic, histaminic, muscarinic or dopaminergic receptors.
In animal models, the administration of Zolmitriptan Zentiva causes vasoconstriction in the carotid arterial circulation. In addition, experimental studies in animals suggest that Zolmitriptan Zentiva inhibits central and peripheral trigeminal nerve activity with inhibition of neuropeptide release (calcitonin gene related peptide (CGRP), vasoactive intestinal peptide (VIP) and Substance P).
Clinical efficacy and safety
In clinical studies with Zolmitriptan Zentiva conventional tablets, the onset of efficacy is apparent from one hour, with increasing efficacy being noted between 2 and 4 hours on headache and other symptoms of migraine such as nausea, photophobia and phonophobia.
Zolmitriptan Zentiva, when administered as conventional oral tablets, is consistently effective in migraine with or without aura and in menstrually associated migraine. Zolmitriptan Zentiva, when administered as conventional oral tablets, if taken during the aura, has not been demonstrated to prevent the migraine headache and therefore Zolmitriptan Zentiva should be taken during the headache phase of migraine.
Paediatric population
One controlled clinical trial in 696 adolescents with migraine failed to demonstrate superiority of Zolmitriptan Zentiva tablets at doses of 2.5 mg, 5 mg and 10 mg over placebo. Efficacy was not demonstrated.
Following oral administration of Zolmitriptan Zentiva conventional tablets zolmitriptan is rapidly and well absorbed (at least 64%) in man. The mean absolute bioavailability of the parent compound is approximately 40%. There is an active metabolite (183C91, the N-desmethyl metabolite) which is also a 5HT IB/1D agonist and is 2 to 6 times as potent, in animal models, as zolmitriptan.
In healthy subjects, when given as a single dose, zolmitriptan and its active metabolite 183C91, display dose-proportional AUC and Cmax over the dose range 2.5 to 50 mg. Absorption is rapid with 75% of Cmax achieved within 1 hour and plasma concentrations are sustained subsequently for 4 to 6 hours. Zolmitriptan absorption is unaffected by the presence of food. There is no evidence of accumulation on multiple dosing of zolmitriptan.
Zolmitriptan is eliminated largely by hepatic biotransformation followed by urinary excretion of the metabolites. There are three major metabolites: the indole acetic acid, (the major metabolite in plasma and urine), the N-oxide and N-desmethyl analogues. The N-desmethylated metabolite (183C91) is active whilst the others are not. Plasma concentrations of 183C91 are approximately half those of the parent drug, hence it would therefore be expected to contribute to the therapeutic action of Zolmitriptan Zentiva Rapimelt. Over 60% of a single oral dose is excreted in the urine (mainly as the indole acetic acid metabolite) and about 30% in faeces, mainly as unchanged parent compound.
A study to evaluate the effect of liver disease on the pharmacokinetics of zolmitriptan showed that the AUC and Cmax were increased by 94% and 50% respectively in patients with moderate liver disease and by 226% and 47% in patients with severe liver disease compared with healthy volunteers. Exposure to the metabolites, including the active metabolite, was decreased. For the 183C91 metabolite, AUC and Cmax were reduced by 33% and 44% in patients with moderate liver disease and by 82% and 90% in patients with severe liver disease.
The plasma half-life (t½) of zolmitriptan was 4.7 hours in healthy volunteers, 7.3 hours in patients with moderate liver disease and 12 hours in those with severe liver disease. The corresponding t½ values for the 183C91 metabolite were 5.7 hours, 7.5 hours and 7.8 hours respectively.
Following intravenous administration, the mean total plasma clearance is approximately 10 ml/min/kg, of which one third is renal clearance. Renal clearance is greater than glomerular filtration rate suggesting renal tubular secretion. The volume of distribution following intravenous administration is 2.4 L/kg. Plasma protein binding is low (approximately 25%). The mean elimination half-life of zolmitriptan is 2.5 to 3 hours. The half-lives of its metabolites are similar, suggesting their elimination is formation-rate limited.
In a small group of healthy individuals there was no pharmacokinetic interaction with ergotamine. Concomitant administration of zolmitriptan with ergotamine/caffeine was well tolerated and did not result in any increase in adverse events or blood pressure changes as compared with zolmitriptan alone.
Following the administration of rifampicin, no clinically relevant differences in the pharmacokinetics of zolmitriptan or its active metabolite were observed.
Selegiline, an MAO-B inhibitor, and fluoxetine (a selective serotonin reuptake inhibitor; SSRI) had no effect on the pharmacokinetic parameters of zolmitriptan.
Zolmitriptan Zentiva Rapimelt was demonstrated to be bioequivalent with the conventional tablet in terms of AUC and Cmax for zolmitriptan and its active metabolite 183C91. Clinical pharmacology data show that the tmax for zolmitriptan can be later for the orally dispersible tablet (range 0.6 to 5h, median 3h) compared to the conventional tablet (range 0.5 to 3h, median 1.5h). The tmax for the active metabolite was similar for both formulations (median 3h).
Renal impairment
Renal clearance of zolmitriptan and all its metabolites is reduced (7 to 8 fold) in patients with moderate to severe renal impairment compared to healthy subjects, although the AUC of the parent compound and the active metabolite were only slightly higher (16 and 35% respectively) with a 1 hour increase in half-life to 3 to 3.5 hours. These parameters are within the ranges seen in healthy volunteers.
Elderly
The pharmacokinetics of zolmitriptan in healthy elderly subjects were similar to those in healthy young volunteers.
Following oral administration of Zomig conventional tablets zolmitriptan is rapidly and well absorbed (at least 64%) in man. The mean absolute bioavailability of the parent compound is approximately 40%. There is an active metabolite (183C91, the N-desmethyl metabolite) which is also a 5HT IB/1D agonist and is 2 to 6 times as potent, in animal models, as zolmitriptan.
In healthy subjects, when given as a single dose, zolmitriptan and its active metabolite 183C91, display dose-proportional AUC and Cmax over the dose range 2.5 to 50 mg. Absorption is rapid with 75% of Cmax achieved within 1 hour and plasma concentrations are sustained subsequently for 4 to 6 hours. Zolmitriptan absorption is unaffected by the presence of food. There is no evidence of accumulation on multiple dosing of zolmitriptan.
Zolmitriptan is eliminated largely by hepatic biotransformation followed by urinary excretion of the metabolites. There are three major metabolites: the indole acetic acid, (the major metabolite in plasma and urine), the N-oxide and N-desmethyl analogues. The N-desmethylated metabolite (183C91) is active whilst the others are not. Plasma concentrations of 183C91 are approximately half those of the parent drug, hence it would therefore be expected to contribute to the therapeutic action of Zolmitriptan Zentiva. Over 60% of a single oral dose is excreted in the urine (mainly as the indole acetic acid metabolite) and about 30% in faeces, mainly as unchanged parent compound.
A study to evaluate the effect of liver disease on the pharmacokinetics of zolmitriptan showed that the AUC and Cmax were increased by 94% and 50% respectively in patients with moderate liver disease and by 226% and 47% in patients with severe liver disease compared with healthy volunteers. Exposure to the metabolites, including the active metabolite, was decreased. For the 183C91 metabolite, AUC and Cmax were reduced by 33% and 44% in patients with moderate liver disease and by 82% and 90% in patients with severe liver disease.
The plasma half-life (t½) of zolmitriptan was 4.7 hours in healthy volunteers, 7.3 hours in patients with moderate liver disease and 12 hours in those with severe liver disease. The corresponding t½ values for the 183C91 metabolite were 5.7 hours, 7.5 hours and 7.8 hours respectively.
Following intravenous administration, the mean total plasma clearance is approximately 10 ml/min/kg, of which one third is renal clearance. Renal clearance is greater than glomerular filtration rate suggesting renal tubular secretion. The volume of distribution following intravenous administration is 2.4 L/kg. Plasma protein binding is low (approximately 25%). The mean elimination half-life of zolmitriptan is 2.5 to 3 hours. The half-lives of its metabolites are similar, suggesting their elimination is formation-rate limited.
In a small group of healthy individuals there was no pharmacokinetic interaction with ergotamine. Concomitant administration of zolmitriptan with ergotamine/caffeine was well tolerated and did not result in any increase in adverse events or blood pressure changes as compared with zolmitriptan alone.
Following the administration of rifampicin, no clinically relevant differences in the pharmacokinetics of zolmitriptan or its active metabolite were observed.
Selegiline, an MAO-B inhibitor, and fluoxetine (a selective serotonin reuptake inhibitor; SSRI) had no effect on the pharmacokinetic parameters of zolmitriptan.
Zolmitriptan Zentiva was demonstrated to be bioequivalent with the conventional tablet in terms of AUC and Cmax for zolmitriptan and its active metabolite 183C91. Clinical pharmacology data show that the tmax for zolmitriptan can be later for the orally dispersible tablet (range 0.6 to 5h, median 3h) compared to the conventional tablet (range 0.5 to 3h, median 1.5h). The tmax for the active metabolite was similar for both formulations (median 3h).
Renal impairment
Renal clearance of zolmitriptan and all its metabolites is reduced (7 to 8 fold) in patients with moderate to severe renal impairment compared to healthy subjects, although the AUC of the parent compound and the active metabolite were only slightly higher (16 and 35% respectively) with a 1 hour increase in half-life to 3 to 3.5 hours. These parameters are within the ranges seen in healthy volunteers.
Elderly
The pharmacokinetics of zolmitriptan in healthy elderly subjects were similar to those in healthy young volunteers.
Absorption
Following oral administration of Zolmitriptan Zentiva conventional tablets, Zolmitriptan Zentiva is rapidly and well absorbed (at least 64%) after oral administration to man. The mean absolute bioavailability of the parent compound is approximately 40%. There is an active metabolite (the N-desmethyl metabolite), which is also a 5HT1B/1D receptor agonist and is 2 to 6 times as potent, in animal models, as Zolmitriptan Zentiva.
In healthy subjects, when given as a single dose, Zolmitriptan Zentiva and its active metabolite, the N-desmethyl metabolite, display dose-proportional AUC and Cmax over the dose range 2.5 to 50 mg. Absorption of Zolmitriptan Zentiva is rapid. In healthy volunteers, 75% of Cmax is achieved within 1 hour, and after this the concentration of Zolmitriptan Zentiva in plasma is maintained at approximately this level until 4-5 hours after dosing.
Zolmitriptan Zentiva absorption is unaffected by the presence of food. There was no evidence of accumulation on multiple dosing of Zolmitriptan Zentiva.
Plasma concentration of Zolmitriptan Zentiva and its metabolites are lower in the first 4 hours after drug administration during a migraine compared with a migraine-free period, suggesting delayed absorption consistent with the reduced rate of gastric emptying observed during a migraine attack.
Zolmitriptan Zentiva orodispersible tablet was demonstrated to be bioequivalent with the conventional tablet in terms of AUC and Cmax for Zolmitriptan Zentiva and its active metabolite 183C91. Clinical pharmacology data show that the tmax for Zolmitriptan Zentiva can be later for the orally dispersible tablet (range 0.6 to 5h, median 3h) compared to the conventional tablet (range 0.5 to 3h, median 1.5h). The tmax for the active metabolite was similar for both formulations (median 3h).
Distribution
The volume of distribution following intravenous administration is 2.4 l/kg. Plasma protein binding of Zolmitriptan Zentiva and the N-desmethyl metabolite is low (approximately 25%).
Biotransformation and elimination
Zolmitriptan Zentiva is eliminated largely by hepatic biotransformation followed by urinary excretion of the metabolites. There are three major metabolites: the indole acetic acid, (the major metabolite in plasma and urine), the N-oxide and N-desmethyl analogues. The N-desmethylated metabolite is active whilst the others are not. Plasma concentrations of the N-desmethylated metabolite are approximately half those of the parent drug, hence it would therefore be expected to contribute to the therapeutic action of Zolmitriptan Zentiva. The mean elimination half-life of Zolmitriptan Zentiva is 2.5 to 3 hours. The half-lives of its metabolites are similar, suggesting their elimination is formation-rate limited. Over 60% of a single oral dose is excreted in the urine (mainly as the indole acetic acid metabolite) and about 30% in faeces mainly as unchanged parent compound.
Hepatic impairment
The metabolism of Zolmitriptan Zentiva is reduced in hepatic impairment in proportion to the extent of the impairment.
A study to evaluate the effect of liver disease on the pharmacokinetics of Zolmitriptan Zentiva showed that the AUC and Cmax were increased by 94% and 50% respectively in patients with moderate liver disease and by 226% and 47% in patients with severe liver disease compared with healthy volunteers. Exposure to the metabolites, including the active metabolite, was decreased. For the 183C91 metabolite, AUC and Cmax were reduced by 33% and 44% in patients with moderate liver disease and by 82% and 90% in patients with severe liver disease.
Renal impairment
Following intravenous administration, the mean total plasma clearance is approximately 10 ml/min/kg, of which one quarter is renal clearance. Renal clearance is greater than glomerular filtration rate suggesting renal tubular secretion.
Renal clearance of Zolmitriptan Zentiva and all its metabolites is reduced (7-8 fold) in patients with moderate to severe renal impairment compared to healthy subjects, although the AUC of the parent compound and the active metabolite were only slightly higher (16 and 35% respectively) with a 1 hour increase in half-life to 3 to 3.5 hours. These parameters are within the ranges seen in healthy volunteers.
Elderly people
The pharmacokinetics of Zolmitriptan Zentiva in healthy elderly subjects were similar to those in healthy young volunteers.
Zolmitriptan Zentiva Rapimelt should only be used where a clear diagnosis of migraine has been established. Care should be taken to exclude other potentially serious neurological conditions. There are no data on the use of Zolmitriptan Zentiva Rapimelt in hemiplegic or basilar migraine. Migraneurs may be at risk of certain cerebrovascular events. Cerebral haemorrhage, subarachnoid haemorrhage, stroke, and other cerebrovascular events have been reported in patients treated with 5HT1B/1D agonists.
Zolmitriptan Zentiva Rapimelt should not be given to patients with symptomatic Wolff-Parkinson-White syndrome or arrhythmias associated with other cardiac accessory conduction pathways.
In very rare cases, as with other 5HT1B/1D agonists, coronary vasospasm, angina pectoris and myocardial infarction have been reported. In patients with risk factors for ischaemic heart disease, cardiovascular evaluation prior to commencement of treatment with this class of compounds, including Zolmitriptan Zentiva Rapimelt, is recommended. These evaluations, however, may not identify every patient who has cardiac disease, and in very rare cases, serious cardiac events have occurred in patients without underlying cardiovascular disease.
As with other 5HT1B/1D agonists, atypical sensations over the precordium have been reported after the administration of zolmitriptan. If chest pain or symptoms consistent with ischaemic heart disease occur, no further doses of zolmitriptan should be taken until after appropriate medical evaluation has been carried out.
As with other 5HT1B/1D agonists transient increases in systemic blood pressure have been reported in patients with and without a history of hypertension; very rarely these increases in blood pressure have been associated with significant clinical events.
As with other 5HT1B/1D agonists, there have been rare reports of anaphylaxis/anaphylactoid reactions in patients receiving Zolmitriptan Zentiva.
Patients with phenylketonuria should be informed that Zolmitriptan Zentiva Rapimelt contains phenylalanine (a component of aspartame). Each 2.5 mg orally dispersible tablet contains 2.81 mg of phenylalanine.
Excessive use of an acute anti-migraine medicinal product may lead to an increased frequency of headache, potentially requiring withdrawal of treatment.
Serotonin Syndrome has been reported with combined use of triptans, and Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs). Serotonin Syndrome is a potentially life-threatening condition, and it may include signs and symptoms such as: mental status changes (e.g. agitation, hallucinations, coma), autonomic instability, (e.g. tachycardia, labile blood-pressure, hyperthermia), neuromuscular aberrations (e.g. hyperreflexia, in-coordination), and/or gastrointestinal symptoms (e.g. nausea, vomiting, diarrhoea). Careful observation of the patient is advised, if concomitant treatment with Zolmitriptan Zentiva Rapimelt and an SSRI or SNRI is clinically warranted, particularly during treatment initiation and dosage increases.
Zolmitriptan Zentiva should only be used where a clear diagnosis of migraine has been established. Care should be taken to exclude other potentially serious neurological conditions. There are no data on the use of Zolmitriptan Zentiva in hemiplegic or basilar migraine. Migraneurs may be at risk of certain cerebrovascular events. Cerebral haemorrhage, subarachnoid haemorrhage, stroke, and other cerebrovascular events have been reported in patients treated with 5HT1B/1D agonists.
Zolmitriptan Zentiva should not be given to patients with symptomatic Wolff-Parkinson-White syndrome or arrhythmias associated with other cardiac accessory conduction pathways.
In very rare cases, as with other 5HT1B/1D agonists, coronary vasospasm, angina pectoris and myocardial infarction have been reported. In patients with risk factors for ischaemic heart disease, cardiovascular evaluation prior to commencement of treatment with this class of compounds, including Zolmitriptan Zentiva, is recommended. These evaluations, however, may not identify every patient who has cardiac disease, and in very rare cases, serious cardiac events have occurred in patients without underlying cardiovascular disease.
As with other 5HT1B/1D agonists, atypical sensations over the precordium have been reported after the administration of zolmitriptan. If chest pain or symptoms consistent with ischaemic heart disease occur, no further doses of zolmitriptan should be taken until after appropriate medical evaluation has been carried out.
As with other 5HT1B/1D agonists transient increases in systemic blood pressure have been reported in patients with and without a history of hypertension; very rarely these increases in blood pressure have been associated with significant clinical events.
As with other 5HT1B/1D agonists, there have been rare reports of anaphylaxis/anaphylactoid reactions in patients receiving Zomig.
Patients with phenylketonuria should be informed that Zolmitriptan Zentiva contains phenylalanine (a component of aspartame). Each 2.5 mg orally dispersible tablet contains 2.81 mg of phenylalanine.
Excessive use of an acute anti-migraine medicinal product may lead to an increased frequency of headache, potentially requiring withdrawal of treatment.
Serotonin Syndrome has been reported with combined use of triptans, and Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs). Serotonin Syndrome is a potentially life-threatening condition, and it may include signs and symptoms such as: mental status changes (e.g. agitation, hallucinations, coma), autonomic instability, (e.g. tachycardia, labile blood-pressure, hyperthermia), neuromuscular aberrations (e.g. hyperreflexia, in-coordination), and/or gastrointestinal symptoms (e.g. nausea, vomiting, diarrhoea). Careful observation of the patient is advised, if concomitant treatment with Zolmitriptan Zentiva and an SSRI or SNRI is clinically warranted, particularly during treatment initiation and dosage increases.
Zolmitriptan Zentiva should only be used where a clear diagnosis of migraine has been established. As with other acute migraine therapies, before treating headaches in patients not previously diagnosed as migraineurs, and in migraineurs who present with atypical symptoms, care should be taken to exclude other potentially serious neurological conditions. Zolmitriptan Zentiva is not indicated for use in hemiplegic, basilar or ophthalmoplegic migraine. Stroke and other cerebrovascular events have been reported in patients treated with 5HT1B/1D agonists. It should be noted that migraneurs may be at risk of certain cerebrovascular events.
Zolmitriptan Zentiva should not be given to patients with symptomatic Wolff-Parkinson-White syndrome or arrythmias associated with other cardiac accessory conduction pathways.
In very rare cases, as with other 5HT1B/1D agonists, coronary vasospasm, angina pectoris and myocardial infarction have been reported. Zolmitriptan Zentiva should not be given to patients with risk factors for ischaemic heart disease (e.g. smoking, hypertension, hyperlipidaemia, diabetes mellitus, heredity) without prior cardiovascular evaluation. Special consideration should be given to postmenopausal women and males over 40 with these risk factors. These evaluations, however, may not identify every patient who has cardiac disease, and in very rare cases, serious cardiac events have occurred in patients without underlying cardiovascular disease.
As with other 5HT1B/1D receptor agonists, heaviness, pressure or tightness over the precordium have been reported after the administration of Zolmitriptan Zentiva. If chest pain or symptoms consistent with ischaemic heart disease occur, no further doses of Zolmitriptan Zentiva should be taken until after appropriate medical evaluation has been carried out.
As with other 5HT1B/1D agonists transient increases in systemic blood pressure have been reported in patients with and without a history of hypertension. Very rarely these increases in blood pressure have been associated with significant clinical events. The dose recommendation for Zolmitriptan Zentiva should not be exceeded.
Undesirable effects may be more common during concomitant use of triptans and herbal preparations containing St John's wort (Hypericum perforatum).
Serotonin syndrome (including altered mental status, autonomic instability and neuromuscular abnormalities) has been reported following concomitant treatment with triptans and selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs). These reactions can be severe. If concomitant treatment with Zolmitriptan Zentiva and an SSRI or SNRI is clinically warranted, appropriate observation of the patient is advised, particularly during treatment initiation, with dose increases, or with addition of another serotonergic medication.
Prolonged use of any type of painkiller for headaches can make them worse. If this situation is experienced or suspected, medical advice should be obtained and treatment should be discontinued. The diagnosis of medication overuse headache should be suspected in patients who have frequent or daily headaches despite (or because of) the regular use of headache medications.
Zolmitriptan Zentiva, when administered as conventional oral tablets, if taken during the aura, has not been demonstrated to prevent the migraine headache and therefore Zolmitriptan Zentiva should be taken during the headache phase of migraine.
This medicinal product contains aspartame, a source of phenylalanine. May be harmful for people with phenylketonuria.
There was no significant impairment of performance of psychomotor tests with doses up to 20 mg zolmitriptan. Zolmitriptan Zentiva has no or negligible influence on the ability to drive and use machines. However it should be taken into account that somnolence may occur.
There was no significant impairment of performance of psychomotor tests with doses up to 20 mg zolmitriptan. Zomig has no or negligible influence on the ability to drive and use machines. However it should be taken into account that somnolence may occur.
In a small group of healthy individuals there was no significant impairment of performance of psychomotor tests with doses up to 20 mg Zolmitriptan Zentiva. Caution is recommended in patients performing skilled tasks (e.g. driving or operating machinery) as drowsiness and other symptoms may occur during a migraine attack.
Posology
The recommended dose of Zolmitriptan Zentiva Rapimelt to treat a migraine attack is 2.5 mg.
If symptoms persist or return within 24 hours, a second dose of zolmitriptan has been shown to be effective. If a second dose is required, it should not be taken within 2 hours of the initial dose.
If a patient does not achieve satisfactory relief with 2.5 mg doses, subsequent attacks can be treated with 5 mg doses of Zolmitriptan Zentiva Rapimelt.
Zolmitriptan is equally effective whenever the tablets are taken during a migraine attack; although it is advisable that Zolmitriptan Zentiva Rapimelt is taken as early as possible after the onset of migraine headache.
In the event of recurrent attacks, it is recommended that the total intake of Zolmitriptan Zentiva Rapimelt in a 24 hour period should not exceed 10 mg.
Zolmitriptan Zentiva Rapimelt is not indicated for prophylaxis of migraine.
Paediatric population (Children below the age of 12 years)
The safety and efficacy of Zolmitriptan Zentiva Rapimelt in children aged 0-12 years has not yet been established. No data are available. Use of Zolmitriptan Zentiva Rapimelt in children is therefore not recommended.
Adolescents (12 - 17 years of age)
The efficacy of Zolmitriptan Zentiva Rapimelt was not demonstrated in a placebo controlled clinical trial for patients aged 12 to 17 years. Use of Zolmitriptan Zentiva Rapimelt in adolescents is therefore not recommended.
Elderly
The safety and efficacy of Zolmitriptan Zentiva Rapimelt in individuals aged over 65 years have not been established.
Hepatic impairment
Metabolism is reduced in patients with hepatic impairment. Therefore for patients with moderate or severe hepatic impairment a maximum dose of 5 mg in 24 hours is recommended.
Renal impairment
No dosage adjustment required.
Method of administration
To be taken by oral administration.
Zolmitriptan Zentiva Rapimelt rapidly dissolves when placed on the tongue and is swallowed with the patient's saliva. A drink of water is not required when taking Zolmitriptan Zentiva Rapimelt. Zolmitriptan Zentiva Rapimelt can be taken when water is not available thus allowing early administration of treatment for a migraine attack. This formulation may also be beneficial for patients who suffer from nausea and are unable to drink during a migraine attack, or for patients who do not like swallowing conventional tablet.
Posology
The recommended dose of Zolmitriptan Zentiva to treat a migraine attack is 2.5 mg.
If symptoms persist or return within 24 hours, a second dose of zolmitriptan has been shown to be effective. If a second dose is required, it should not be taken within 2 hours of the initial dose.
If a patient does not achieve satisfactory relief with 2.5 mg doses, subsequent attacks can be treated with 5 mg doses of Zolmitriptan Zentiva.
Zolmitriptan is equally effective whenever the tablets are taken during a migraine attack; although it is advisable that Zolmitriptan Zentiva is taken as early as possible after the onset of migraine headache.
In the event of recurrent attacks, it is recommended that the total intake of Zolmitriptan Zentiva in a 24 hour period should not exceed 10 mg.
Zolmitriptan Zentiva is not indicated for prophylaxis of migraine.
Paediatric population (Children below the age of 12 years)
The safety and efficacy of Zolmitriptan Zentiva in children aged 0-12 years has not yet been established. No data are available. Use of Zolmitriptan Zentiva in children is therefore not recommended.
Adolescents (12 - 17 years of age)
The efficacy of Zolmitriptan Zentiva was not demonstrated in a placebo controlled clinical trial for patients aged 12 to 17 years. Use of Zolmitriptan Zentiva in adolescents is therefore not recommended.
Elderly
The safety and efficacy of Zolmitriptan Zentiva in individuals aged over 65 years have not been established.
Hepatic impairment
Metabolism is reduced in patients with hepatic impairment. Therefore for patients with moderate or severe hepatic impairment a maximum dose of 5 mg in 24 hours is recommended.
Renal impairment
No dosage adjustment required.
Method of administration
To be taken by oral administration.
Zolmitriptan Zentiva rapidly dissolves when placed on the tongue and is swallowed with the patient's saliva. A drink of water is not required when taking Zolmitriptan Zentiva. Zolmitriptan Zentiva can be taken when water is not available thus allowing early administration of treatment for a migraine attack. This formulation may also be beneficial for patients who suffer from nausea and are unable to drink during a migraine attack, or for patients who do not like swallowing conventional tablet.
Posology
The recommended dose of Zolmitriptan Zentiva to treat a migraine attack is 2.5 mg. It is advisable that Zolmitriptan Zentiva is taken as early as possible after the onset of migraine headache but it is also effective if taken at a later stage.
If symptoms of migraine should recur within 24 hours following an initial response, a second dose may be taken. If a second dose is required, it should not be taken within 2 hours of the initial dose. If a patient does not respond to the first dose, it is unlikely that a second dose will be of benefit in the same attack.
If a patient does not achieve satisfactory relief with 2.5 mg doses, for subsequent attacks 5 mg doses of Zolmitriptan Zentiva could be considered. Caution is advised due to an increased incidence of side effects. A controlled clinical study failed to demonstrate superiority of the 5 mg dose over the 2.5 mg dose. Nevertheless a 5 mg dose may be of benefit in some patients.
The total daily intake should not exceed 10 mg. Not more than 2 doses of Zolmitriptan Zentiva should be taken in any 24-hour period.
Special populations
Use in patients aged over 65 years
The safety and efficacy of Zolmitriptan Zentiva in individuals aged over 65 years have not been evaluated. Use of Zolmitriptan Zentiva in the elderly is therefore not recommended.
Patients with hepatic impairment
The metabolism of Zolmitriptan Zentiva is reduced in patients with hepatic impairment. For patients with moderate or severe hepatic impairment, a maximum dose of 5 mg in 24 hours is recommended. However, no dose adjustment is required for patients with mild hepatic impairment.
Patients with renal impairment
No dosage adjustment required in patients with a creatinine clearance of more than 15 ml/min.
Interactions requiring dose adjustment
For patients taking MAO-A inhibitors, a maximum dose of 5 mg in 24 hours is recommended.
A maximum dose of 5 mg Zolmitriptan Zentiva in 24 hours is recommended in patients taking cimetidine.
A maximum dose of 5 mg Zolmitriptan Zentiva in 24 hours is recommended in patients taking specific inhibitors of CYP 1A2 such as fluvoxamine and the quinolones (eg ciprofloxacin).
Paediatric population
Use in Children (under 12 years of age)
Safety and efficacy of Zolmitriptan Zentiva in paediatric patients have not been evaluated. Use of Zolmitriptan Zentiva in children is therefore not recommended.
Adolescents (12 - 17 years of age)
The efficacy of Zolmitriptan Zentiva was not demonstrated in a placebo controlled clinical trial for patients aged 12 to 17 years. Use of Zolmitriptan Zentiva in adolescents is therefore not recommended.
Method of administration
For oral use.
The tablet need not be taken with liquid; the tablet dissolves on the tongue and is swallowed with saliva. This formulation can be used in situations in which liquids are not available, or to avoid the nausea and vomiting that may accompany the ingestion of tablets with liquids. However, a delay in the absorption of Zolmitriptan Zentiva from Zolmitriptan Zentiva can occur which may delay onset of action.
The blister pack should be peeled open as shown on the foil (tablets should not be pushed through the foil). The Zolmitriptan Zentiva tablet should be placed on the tongue, where it will dissolve and be swallowed with the saliva.
The blister pack should be peeled open as shown on the foil (tablets should not be pushed through the foil). The Zolmitriptan Zentiva Rapimelt tablet should be placed on the tongue, where it will dissolve and be swallowed with the saliva.
No special requirements for disposal.
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
The blister pack should be peeled open as shown on the foil (tablets should not be pushed through the foil). The Zolmitriptan Zentiva tablet should be placed on the tongue, where it will dissolve and be swallowed with the saliva.
No special requirements for disposal.
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
No special requirements
