CMigraine during breastfeeding
Second line
Migraine during breastfeeding
Second line
Migraine in nursing mothers. Dose 2.5–5 mg orally or 5 mg nasally, repeat at 2 h. Max 10 mg/day. Nasal form – 15-min onset.
Sources
ICD-10: G43.9 · ICD-11: 8A80.Z
Zolmitriptan
AEMPSTriptan, selective 5HT1B/1D receptor agonist
ATC code: N02CC03
Brand names: Zomig
Updated · Methodology
Indications
C
How to read tiers A–F
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit
Mechanism of action
Activates 5HT1B/1D receptors on dural vessels and trigeminal pathways, causes vasoconstriction and suppresses neuropeptide release. Aborts migraine within 30–60 minutes. CYP1A2 produces an active metabolite that MAO-A then oxidizes, so concurrent MAO inhibitors are contraindicated.
Safety
Contraindications
- Hypersensitivity to triptans or sulfonamides
- Ischaemic heart disease, prior myocardial infarction, Prinzmetal angina
- Uncontrolled hypertension
- Cerebrovascular disease and prior transient ischaemic attack
- Peripheral arterial disease
- Co-administration with ergotamine, dihydroergotamine or another triptan within 24 hours
- Co-administration with MAOIs within 14 days
- Severe hepatic impairment
Serious adverse effects
- Coronary vasospasm with myocardial infarction
- Ischaemic stroke and transient ischaemic attack
- Serotonin syndrome when combined with SSRIs/SNRIs/TCAs
- Hypersensitivity reactions including anaphylaxis
- Medication-overuse headache (use >10 days per month)
Common adverse effects
- Dizziness
- Somnolence
- Hot flushes
- Paraesthesia
- Chest or throat tightness (non-ischaemic)
- Nausea
- Dry mouth
Pregnancy: can you take Zolmitriptan?
AEMPS summary of product characteristics (section 4.6): the safety of zolmitriptan in human pregnancy has not been established. Animal studies do not indicate direct teratogenic effects, but some embryotoxicity findings suggested reduced embryo viability. Zolmitriptan should be considered only if the expected benefit to the mother justifies the potential risk to the fetus.
Breastfeeding: can you take Zolmitriptan?
Hale L3 · Probably compatible, limited dataCompatible. Hale L3, limited data. Available as nasal spray (Zomig) with rapid onset. Wait 4–8 h before feeding.
- Maternal half-life
- 3 h
- Maternal peak time
- 2 h
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Drug–drug interactions
3 pairs found. Sorted from critical to minor.
CriticalMoclobemideReversible MAO-A inhibitor (RIMA)
Mechanism
Moclobemide is a reversible inhibitor of monoamine oxidase A (MAO-A), the enzyme that breaks down serotonin and clears zolmitriptan and its active N-desmethyl metabolite. After moclobemide, zolmitriptan exposure (AUC) rose by 26% and the AUC of the active metabolite rose 3-fold (zolmitriptan SmPC, AEMPS, section 4.5). Zolmitriptan is a 5-HT1B/1D agonist and moclobemide raises serotonin levels, so their serotonergic effects add up. The moclobemide SmPC lists triptans among contraindicated combinations, and the label of zolmitriptan contraindicates use with any MAO-A inhibitor.
Symptoms
The main danger is serotonin syndrome: spontaneous or inducible clonus, agitation and sweating, tremor and hyperreflexia, hypertonia with a temperature above 38 °C, confusion, swings in heart rate and blood pressure, nausea, vomiting, diarrhoea (zolmitriptan SmPC, AEMPS, and label). Symptoms usually start within minutes to hours after a new or higher dose of a serotonergic drug (FDA label of zolmitriptan). Higher zolmitriptan exposure also strengthens its own effects: heaviness, pressure or tightness in the chest, throat and neck, and a rise in blood pressure.
Management
The combination is contraindicated: the moclobemide SmPC lists triptans among contraindicated drugs and names zolmitriptan explicitly (moclobemide SmPC, AEMPS, sections 4.3 and 4.5). The label of zolmitriptan contraindicates it in patients taking an MAO-A inhibitor or within 2 weeks of stopping one (FDA label of zolmitriptan, sections 4 and 7.2). The Spanish zolmitriptan SmPC is softer: with an MAO-A inhibitor it caps the dose at 5 mg per 24 hours and bans the combination only when moclobemide exceeds 150 mg twice daily (zolmitriptan SmPC, AEMPS, sections 4.2 and 4.5). The strictest document wins, so do not prescribe zolmitriptan to a patient on moclobemide. After stopping moclobemide, allow zolmitriptan no earlier than 2 weeks later (FDA label of zolmitriptan, section 4). If the patient has taken the drugs together and signs of serotonin syndrome appear, stop both serotonergic drugs. Withdrawal brings rapid improvement, and further treatment depends on the severity of symptoms (zolmitriptan SmPC, AEMPS, section 4.4; FDA label of zolmitriptan, section 5.7).
Sources
CriticalPhenelzineAntidepressant, irreversible non-selective monoamine oxidase inhibitor (MAO-A and MAO-B)
Mechanism
Zolmitriptan is MAO-A + CYP1A2 substrate. With phenelzine – fatal serotonin syndrome.
Symptoms
Agitation, tachycardia, hyperthermia, myoclonus, hyperreflexia within hours.
Management
Combination contraindicated. 14 days after MAOI withdrawal before starting triptan.
CriticalTranylcypromineAntidepressant, irreversible non-selective monoamine oxidase inhibitor (MAO-A and MAO-B), amphetamine derivative
Mechanism
MAO-A inhibition + zolmitriptan – fatal serotonin syndrome.
Symptoms
Agitation, tachycardia, hyperthermia, myoclonus, hyperreflexia within hours.
Management
Combination contraindicated. 14 days after MAOI withdrawal before starting triptan.
Sources
Label mentions21 mentions
Verbatim lines from the interaction sections, in the language of the label
From this drug’s label
- CriticalDihydroergotamine
«CONTRAINDICATIONS: • Recent use (i.e., within 24 hours) of another 5-HT 1 agonist, ergotamine-containing medication, or ergot-type medication (such as dihydroergotamine or methysergide) [see Drug…»
FDA, section 4 · Open on DailyMed
- CriticalErgotamine
«Los datos obtenidos de los sujetos sanos sugieren que no existen interacciones farmacocinéticas ni clínicamente significativas entre zolmitriptán y ergotamina. Sin embargo, el aumento de riesgo de…»
AEMPS, section 4.5 · Open on CIMA
- CriticalErgotamine
«CONTRAINDICATIONS: • Recent use (i.e., within 24 hours) of another 5-HT 1 agonist, ergotamine-containing medication, or ergot-type medication (such as dihydroergotamine or methysergide) [see Drug…»
FDA, section 4 · Open on DailyMed
- MajorCiprofloxacin
«Tras la administración de cimetidina, un inhibidor general de P450, la vida media de zolmitriptán aumentó en un 44% y el AUC aumentó en un 48%. Además, se duplicaron los valores de la vida media y…»
AEMPS, section 4.5 · Open on CIMA
- MajorFluvoxamine
«Tras la administración de cimetidina, un inhibidor general de P450, la vida media de zolmitriptán aumentó en un 44% y el AUC aumentó en un 48%. Además, se duplicaron los valores de la vida media y…»
AEMPS, section 4.5 · Open on CIMA
- MajorMoclobemide
«Después de la administración de moclobemida, un inhibidor específico de la MAO-A, se produjo un pequeño aumento (26%) en la AUC de zolmitriptán, e igualmente, un incremento de 3 veces en el mismo…»
AEMPS, section 4.5 · Open on CIMA
- Moderatequinolonasclass named in the label
«Tras la administración de cimetidina, un inhibidor general de P450, la vida media de zolmitriptán aumentó en un 44% y el AUC aumentó en un 48%. Además, se duplicaron los valores de la vida media y…»
AEMPS, section 4.5 · Open on CIMA
«La selegilina (inhibidor de MAO-B) y la fluoxetina no afectan los parámetros farmacocinéticos del zolmitriptán. Las dosis terapéuticas de los inhibidores selectivos de la recaptación de la serotonina…»
AEMPS, section 4.5 · Open on CIMA
«No hay evidencia de que el uso concomitante de medicamentos profilácticos para la migraña tenga algún efecto en la eficacia o en los efectos adversos de zolmitriptán (por ejemplo beta-bloquenates…»
AEMPS, section 4.5 · Open on CIMA
«La selegilina (inhibidor de MAO-B) y la fluoxetina no afectan los parámetros farmacocinéticos del zolmitriptán. Las dosis terapéuticas de los inhibidores selectivos de la recaptación de la serotonina…»
AEMPS, section 4.5 · Open on CIMA
«La selegilina (inhibidor de MAO-B) y la fluoxetina no afectan los parámetros farmacocinéticos del zolmitriptán. Las dosis terapéuticas de los inhibidores selectivos de la recaptación de la serotonina…»
AEMPS, section 4.5 · Open on CIMA
- ISRSclass named in the label
«La selegilina (inhibidor de MAO-B) y la fluoxetina no afectan los parámetros farmacocinéticos del zolmitriptán. Las dosis terapéuticas de los inhibidores selectivos de la recaptación de la serotonina…»
AEMPS, section 4.5 · Open on CIMA
- medicamentos serotoninérgicosclass named in the label
«La selegilina (inhibidor de MAO-B) y la fluoxetina no afectan los parámetros farmacocinéticos del zolmitriptán. Las dosis terapéuticas de los inhibidores selectivos de la recaptación de la serotonina…»
AEMPS, section 4.5 · Open on CIMA
«La selegilina (inhibidor de MAO-B) y la fluoxetina no afectan los parámetros farmacocinéticos del zolmitriptán. Las dosis terapéuticas de los inhibidores selectivos de la recaptación de la serotonina…»
AEMPS, section 4.5 · Open on CIMA
«La selegilina (inhibidor de MAO-B) y la fluoxetina no afectan los parámetros farmacocinéticos del zolmitriptán. Las dosis terapéuticas de los inhibidores selectivos de la recaptación de la serotonina…»
AEMPS, section 4.5 · Open on CIMA
«La selegilina (inhibidor de MAO-B) y la fluoxetina no afectan los parámetros farmacocinéticos del zolmitriptán. Las dosis terapéuticas de los inhibidores selectivos de la recaptación de la serotonina…»
AEMPS, section 4.5 · Open on CIMA
- SSRIs/SNRIsclass named in the label
«Selective Serotonin Reuptake Inhibitors and Serotonin Norepinephrine Reuptake Inhibitors: Cases of life-threatening serotonin syndrome have been reported during co-administration of triptans and…»
FDA, section 7 · Open on DailyMed
«La selegilina (inhibidor de MAO-B) y la fluoxetina no afectan los parámetros farmacocinéticos del zolmitriptán. Las dosis terapéuticas de los inhibidores selectivos de la recaptación de la serotonina…»
AEMPS, section 4.5 · Open on CIMA
From other drugs’ labels
- CriticalMoclobemide
«La administración conjunta de Manerix con triptanos está contraindicada ya que éstos son potentes receptores agonistas serotoninérgicos metabolizados por las monoaminooxidasas (MAOs) y varios enzimas…»
AEMPS, section 4.5 · Open on CIMA
- CriticalRizatriptan
«Ergotamina, derivados de la ergotamina (incluyendo metisérgida) y otros agonistas de los receptores 5 HT 1B/
1D : Debido a un efecto aditivo, el uso concomitante de rizatriptán y ergotamina, derivados…» AEMPS, section 4.5 · Open on CIMA
- CriticalSelegiline
«Agonistas de la serotonina: La selegilina no debe utilizarse en combinación con agonistas de la serotonina (por ejemplo, sumatriptán, naratriptán, zolmitriptán, rizatriptán, lasmiditán) debido al…»
AEMPS, section 4.5 · Open on CIMA
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Frequently asked
What is Zolmitriptan used for?
Zolmitriptan is evaluated for the following indications with varying evidence strength: Migraine during breastfeeding (evidence tier C). See the full indication matrix with dosing and citations above on this page.
What are the side effects of Zolmitriptan?
Common side effects of Zolmitriptan (≥ 1 in 100): Dizziness, Somnolence, Hot flushes, Paraesthesia, Chest or throat tightness (non-ischaemic), Nausea. See the Safety section for uncommon and serious reactions.
Is Zolmitriptan safe during pregnancy?
AEMPS summary of product characteristics (section 4.6): the safety of zolmitriptan in human pregnancy has not been established. Animal studies do not indicate direct teratogenic effects, but some embryotoxicity findings suggested reduced embryo viability. Zolmitriptan should be considered only if the expected benefit to the mother justifies the potential risk to the fetus.
Is Zolmitriptan compatible with breastfeeding?
Compatible. Hale L3, limited data. Available as nasal spray (Zomig) with rapid onset. Wait 4–8 h before feeding.
Who should not take Zolmitriptan?
Zolmitriptan is contraindicated in: Hypersensitivity to triptans or sulfonamides; Ischaemic heart disease, prior myocardial infarction, Prinzmetal angina; Uncontrolled hypertension; Cerebrovascular disease and prior transient ischaemic attack; Peripheral arterial disease. Full list in the Safety section.
Official sources
Direct links to regulator labels. Open in a new tab.
- AEMPS / CIMALabel dated 12/28/2024
- FDA / DailyMedLabel dated 01/29/2026
Other drugs in this group
Almotriptan, Buprenorphine (transdermal), Dihydroergotamine, Eletriptan, Meperidine, Oxycodone, Rizatriptan, Ergotamine