Zolmitriptan is a selective
serotonin 5-HT1B/1D receptor agonist ('
triptan'). Its efficacy and tolerability have been assessed in a number of randomised, placebo-controlled, double-blind trials in large numbers of adults with moderate to severe
migraine attacks. Oral
zolmitriptan 2.5 and 5mg has a rapid onset of action (significant
headache relief is observed at 45 minutes) and efficacy is sustained in most patients who respond at 2 hours. The
drug is significantly more effective than placebo as measured by a number of parameters including 2-hour
headache response rates and
pain-free response rates. Other symptoms of
migraine, including
nausea,
photophobia and
phonophobia are also alleviated with
zolmitriptan.
Zolmitriptan is effective in the treatment of
migraine associated with menses and
migraine with aura. There is some evidence to support the use of
zolmitriptan in patients with
migraine who have had a poor response to previous
therapy. The efficacy of
zolmitriptan appears to be maintained, with no tachyphylaxis, following repeated administration for multiple attacks of
migraine over a prolonged period of time, with high
headache response rates reported over all attacks. In comparison with placebo, the incidence of persistent
migraine headache is reduced by
zolmitriptan and recurrent
migraine headache occurs less frequently with the active treatment.
Zolmitriptan has also demonstrated efficacy in the treatment of persistent and/or recurrent
migraine headache. For relief of
migraine headache,
zolmitriptan 5mg had similar efficacy to
sumatriptan 100mg for a single attack, but generally was more effective than
sumatriptan 25 and 50mg for multiple attacks, in single trials. The incidence of recurrent
headache with
zolmitriptan was similar to that with
sumatriptan.
Zolmitriptan is generally well tolerated with most adverse events being mild to moderate, transient and resolving without intervention or the need for treatment withdrawal. The most common adverse events with
zolmitriptan therapy are
asthenia, heaviness other than that of the chest or neck, dry mouth,
nausea,
dizziness,
somnolence, paraesthesia, warm sensation, tightness, vasodilation and
chest pain.
CONCLUSION:
Zolmitriptan is effective across a wide range of
migraine subtypes, maintains efficacy when used in the long term and is generally well tolerated. Further clinical experience is necessary to define the position of
zolmitriptan among other currently or soon to be available selective 5-HT1B/1D receptor agonists. However, on the basis of available data,
zolmitriptan should emerge as a useful treatment option in the management of patients with moderate to severe
migraine.