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.
Triptan, selective 5HT1B/1D receptor agonist
ATC code: N02CC03 (Zolmitriptan)
Brand names
Zomig
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.
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.
2 pairs found. Sorted from critical to minor.
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.
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.
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AEMPS Category C. Post-marketing registries do not show major malformations; first-trimester exposure data are limited to several hundred cases. SEN advises paracetamol first; sumatriptan remains the best-studied triptan in pregnancy. Zolmitriptan is considered when attacks are severe and better-studied options have been exhausted.
Compatible. Hale L3, limited data. Available as nasal spray (Zomig) with rapid onset. Wait 4-8 h before feeding.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
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.
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.
FDA category C. AEMPS Category C. Post-marketing registries do not show major malformations; first-trimester exposure data are limited to several hundred cases. SEN advises paracetamol first; sumatriptan remains the best-studied triptan in pregnancy. Zolmitriptan is considered when attacks are severe and better-studied options have been exhausted.
Compatible. Hale L3, limited data. Available as nasal spray (Zomig) with rapid onset. Wait 4-8 h before feeding.
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.