Precautions and Warnings With Zolmitriptan (Cont.)

• Medications like zolmitriptan have been reported to increase the risk of a heart attack or a life-threatening change in a person's heart rhythm (arrhythmia). You should not take zolmitriptan if you have heart disease or a history of a heart attack, stroke, or transient ischemic attack (TIA or "mini-stroke") (see Zomig and Heart Problems for more information).

If you have risk factors for heart disease (see Heart Disease Risk Factors), it is also strongly recommended that you take your first dose of zolmitriptan in your healthcare provider's office so that he or she can monitor your heart. You should also have your heart checked periodically while taking zolmitriptan.

• In some cases, a stroke or transient ischemic attack ("mini stroke") can be misdiagnosed as a migraine. Your healthcare provider should make sure you are not having a stroke, especially if you have never had migraines in the past (see Stroke Symptoms for more information on the symptoms of a stroke).
   
• You should not take zolmitriptan if you have an irregular heart rhythm (arrhythmia), including Wolff-Parkinson-White syndrome.
   
• If you have chest pain or tightness in the jaw or neck after taking zolmitriptan, contact your healthcare provider immediately. These side effects are fairly common with zolmitriptan and are not usually serious. However, your healthcare provider may need to make sure you are not having heart problems.
   
• Medications like zolmitriptan can cause blood vessels in the arms, legs, colon (large intestine), and other locations to spasm. This can cause a decrease in blood flow to these areas. Symptoms will vary based on the location. For example, a spasm in the colon can lead to severe abdominal pain (or stomach pain) or bloody diarrhea.
   
• Taking zolmitriptan with certain antidepressants, including selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs), can increase your risk of a dangerous group of symptoms called serotonin syndrome. Do not use zolmitriptan with depression medications without first discussing it with your healthcare provider. Contact your healthcare provider immediately if you have any possible symptoms of serotonin syndrome, including:

• Confusion
• Seeing or hearing things that are not really there (hallucinations)
• A fast heartbeat (tachycardia)
• Feeling faint
• A fever
• Sweating
• Muscle spasms
• Difficulty walking
• Diarrhea.

• Zolmitriptan can cause an increase in blood pressure. You should not take zolmitriptan if you have untreated high blood pressure (hypertension).
   
• Zolmitriptan orally disintegrating tablets (but not regular zolmitriptan tablets) contain phenylalanine. This is important for people with phenylketonuria, who must limit their phenylalanine intake.
   
• Tell your healthcare provider if you have liver problems (including liver failure or cirrhosis) before taking zolmitriptan. This is important because the liver helps to remove zolmitriptan from the body.
   
• Zolmitriptan is considered a pregnancy Category C medication. This means that zolmitriptan may not be safe for use during pregnancy. Talk with your healthcare provider before using zolmitriptan if you are pregnant (see Zomig and Pregnancy for more information).
   
• It is not known if zolmitriptan passes through breast milk. Therefore, if you are breastfeeding or plan to start breastfeeding, be sure to talk with your healthcare provider about this.
   
• Zolmitriptan can interact with certain other medications (see Drug Interactions With Zolmitriptan).