Zolmitriptan

INTRODUCTION

Indications

Acute treatment of migraine headache.

Action

Acts as an agonist at specific 5-HT₁ receptor sites in intracranial blood vessels and sensory trigeminal nerves. Therapeutic Effects: Cranial vessel vasoconstriction with resultant decrease in migraine headache.

Adverse Reactions/Side Effects

CNS: dizziness, drowsiness, vertigo, weakness. EENT: throat pain/tightness/pressure. CV: chest pain/pressure/tightness/heaviness, hypertension, palpitations. GI: dry mouth, dyspepsia, dysphagia, nausea. Derm: sweating, warm/cold sensation. MS: myalgia, myasthenia. Neuro: hypesthesia, paresthesia. Misc: feeling of heaviness.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess the duration and severity of headaches, and document whether drug therapy is successful in decreasing migraine attacks.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).

• Monitor any chest pain or other chest symptoms (pressure, tightness, heaviness, palpitations). Attempt to determine if symptoms are drug induced or caused by cardiovascular dysfunction (e.g., angina that occurs during exercise).

• Assess any muscle pain or weakness to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess signs of paresthesia (numbness, tingling) or hypesthesia (decreased sensation). Perform objective tests, including electroneuromyography and sensory testing, to document any drug-related neuropathic changes.

• Watch for dizziness and vertigo that affects gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

• Implement appropriate interventions (manual techniques, physical agents, therapeutic exercise) to manage headache pain and reduce the need for drug therapy. Help patient also explore other nonpharmacologic methods to reduce chronic headache pain (relaxation techniques, imagery, and so forth).

• If a headache occurs and drug treatment is needed during a rehabilitation session, allow patient to recover in a quiet, darkened room to allow the drug to achieve maximal effects.

Patient/Client-Related Instruction

• Advise the patient to bring this drug to each therapy session; this drug is most effective when taken at the first signs of a migraine attack. Make sure patients understand the correct administration techniques for intranasal inhalation.

• Advise patient to adhere to the correct dosing schedule, and to not exceed the recommended frequency and number of doses per 24-hr period.

• Instruct patient to report other troublesome side effects such as severe or prolonged headache, drowsiness, throat pain/tightness, skin reactions (sweating, warmth, cold, other strange sensations), or GI problems (nausea, dry mouth, indigestion, difficulty swallowing).

Pharmacokinetics

Absorption: Well absorbed (40%) following oral and intranasal administration.