Zomig interactions: Alcohol, medications, and other factors

Before you start treatment with Zomig, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Zomig interacts with supplements, herbs, or vitamins, see the “Zomig and other interactions” section below.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Zomig. Keep in mind that this table doesn’t include all drugs that may interact with Zomig. Some of these interactions are described in detail just below in “Drug interactions in depth.”

In some cases, factors or conditions could prevent your doctor from prescribing Zomig due to the risk of harm. These are known as contraindications. The contraindications of Zomig include:

Having ischemic bowel disease

Doctors typically will not prescribe Zomig for people with ischemic bowel disease. This is because Zomig may cause blood vessel or circulation problems, which could worsen this condition.

If you have ischemic bowel disease, talk with your doctor before taking Zomig. They’ll likely prescribe a treatment other than Zomig for your migraine episodes.

Having basilar or hemiplegic migraine

Doctors typically will not prescribe Zomig for people with basilar or hemiplegic migraine. This is because the risk of stroke may be higher if you take Zomig while you have either condition.

If you have basilar or hemiplegic migraine, talk with your doctor before taking Zomig. They’ll likely prescribe a treatment for migraine other than Zomig.

Having certain cardiovascular conditions

Doctors typically will not prescribe Zomig for people with certain cardiovascular conditions. These include:

• high blood pressure that is not well managed
• ministroke or stroke
• peripheral vascular disease
• coronary artery spasm or coronary artery disease, including angina or heart attack
• problems with the electrical activity of your heart, including Wolff-Parkinson-White syndrome

This is because Zomig may cause cardiovascular-related side effects. Examples include irregular heart rhythm, stroke, and high blood pressure. Your risk of these side effects may be higher if you have any of the cardiovascular conditions above.

If you have a cardiovascular condition, talk with your doctor before taking Zomig. They’ll likely prescribe a migraine treatment other than Zomig.

Taking certain other migraine drugs

Doctors typically will not prescribe Zomig in combination with certain other migraine medications. (Zomig is a triptan drug that’s prescribed to treat migraine episodes.)

Zomig and these migraine drugs may cause blood vessel or circulation problems. Your risk of these side effects may be higher if you take these drugs together.

Below are some other migraine drugs that may interact with Zomig:

• other triptan drugs, such as frovatriptan (Frova) and rizatriptan (Maxalt and Maxalt-MLT, Rizafilm)
• ergot drugs, such as ergotamine (Ergomar) and dihydroergotamine (Migranal, Trudhesa)

Before you start treatment with Zomig, tell your doctor if you take any of the migraine drugs above. They’ll likely have you wait at least 24 hours after your last dose before starting treatment with Zomig. Likewise, after you stop taking Zomig, your doctor will typically have you wait at least 24 hours before starting treatment with any migraine drug listed above.

Taking certain MAOIs

Doctors typically will not prescribe Zomig in combination with certain MAOIs, which are usually antidepressants. However, there is also an MAOI, linezolid (Zyvox), that’s an antibiotic.

Certain MAOIs can slow the breakdown of Zomig in your body. This can lead to a higher level of Zomig in your system, increasing your risk of side effects. (For information about Zomig’s side effects, see this article.)

Below are a few examples of MAOIs that can interact with Zomig:

• phenelzine (Nardil)
• isocarboxazid (Marplan)
• tranylcypromine (Parnate)
• linezolid (Zyvox)

Before you start treatment with Zomig, tell your doctor if you take an MAOI. They can tell you whether it’s safe to take Zomig with the MAOI you’re prescribed.

With certain MAOIs, your doctor may stop the drug and wait at least 2 weeks to start Zomig treatment. Likewise, after you stop taking Zomig, they’ll typically have you wait at least 2 weeks before starting treatment with certain MAOIs.

Having had an allergic reaction to Zomig or any of its ingredients

If you’ve had an allergic reaction to Zomig or any of its ingredients, your doctor will likely not prescribe Zomig. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Note: Before you start treatment with Zomig, it’s important to tell your doctor if these contraindications apply to you. They can determine whether to prescribe Zomig.

There are no known interactions between Zomig and alcohol.

However, alcohol can be a migraine trigger for some people. (Zomig is prescribed to treat migraine episodes.) If alcohol brings on your episodes, your doctor may advise you to limit or avoid it during Zomig treatment.

If you have questions about drinking alcohol while taking Zomig, talk with your doctor or pharmacist.

Here’s a closer look at certain drug interactions of Zomig.

TCAs

TCAs are prescribed to treat depression. They may also be prescribed off-label for other uses, including migraine prevention. (Off-label use is when doctors prescribe a drug for a purpose other than what it’s approved for.)

Interaction result: Taking Zomig with a TCA may increase the risk of serotonin syndrome with either drug.

Interaction explained: Both Zomig and TCAs can cause serotonin syndrome as a side effect. The risk of this side effect may be greater when these drugs are taken together. (To learn more about Zomig’s side effects, see this article.)

With serotonin syndrome, you have a high level of the chemical serotonin in your body. A high serotonin level can cause symptoms, such as excessive sweating, blood pressure changes, and nausea or vomiting. Serotonin syndrome can be life threatening for some people.

Examples of TCAs: Here are some TCAs that may interact with Zomig:

• amitriptyline
• imipramine (Tofranil)
• nortriptyline (Pamelor)

Steps you or your doctor may take: Before starting Zomig, tell your doctor if you take a TCA. They can recommend whether it’s safe to take them together.

If your doctor prescribes them together, watch for symptoms of serotonin syndrome. If you have symptoms of this condition, tell your doctor right away. If your symptoms seem life threatening, contact 911 or a local emergency number immediately.

If you have serotonin syndrome, your doctor will likely recommend that you stop taking these medications together. They can recommend other treatment options instead.

To learn more about Zomig and TCAs, talk with your doctor or pharmacist.

Propranolol

Doctors may prescribe propranolol (Hemangeol, Innopran XL, others) for heart-related conditions, including high blood pressure. It’s also prescribed for migraine prevention.

Interaction result: Taking Zomig with propranolol can increase the risk of side effects from Zomig.

Interaction explained: Taking Zomig with propranolol may increase the level of Zomig in your system. This can raise your risk of side effects from Zomig. Examples include nausea, dizziness, and sleepiness.

Steps you or your doctor may take: Before taking Zomig, tell your doctor if you’re taking propranolol. They can recommend whether it’s safe to take these medications together.

If your doctor prescribes Zomig with propranolol, tell them about any bothersome side effects of Zomig. They can recommend ways to manage your side effects or prescribe a different treatment option instead.

For more information about Zomig and propranolol, talk with your doctor or pharmacist.

Cimetidine

Cimetidine (Tagamet HB) is used to ease symptoms of conditions such as heartburn and indigestion. It’s available over the counter, meaning you don’t need a prescription to purchase it.

Interaction result: Taking Zomig with cimetidine can increase the risk of side effects of Zomig.

Interaction explained: Taking Zomig with cimetidine may raise the level of Zomig in your system. This can increase your risk of side effects from Zomig. (For details about Zomig’s side effects, see this article.)

Steps you or your doctor may take: Before taking Zomig, be sure to tell your doctor if you’re taking cimetidine. Also, talk with them before taking cimetidine during Zomig treatment. They can recommend options other than cimetidine that can ease heartburn or indigestion.

If you take Zomig with cimetidine, your doctor will likely lower your dosage of Zomig. Doing so can help reduce your risk of side effects from the drug. To learn more about the dosage of Zomig, see this article.

To learn more about Zomig and cimetidine, talk with your doctor or pharmacist.

Zomig may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Zomig.

Zomig interactions with supplements

Before you start treatment with Zomig, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Zomig interactions with herbs

Doctors may recommend that you avoid taking Zomig with St. John’s wort. This is an herbal supplement used to ease symptoms of depression and other conditions.

Taking St. John’s wort during Zomig treatment may increase the risk of serotonin syndrome. With this condition, you have a high level of the chemical serotonin in your body. A high serotonin level can cause symptoms such as excessive sweating, blood pressure changes, and nausea or vomiting. Serotonin syndrome can be life threatening for some people.

Due to this risk, a doctor may suggest a treatment option other than St. John’s wort that does not interact with Zomig.

Zomig and vitamins

There are no reports of vitamins interacting with Zomig. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Zomig.

Zomig and food

There were no reports of food interactions with Zomig. If you’d like to learn more about eating certain foods during treatment with Zomig, talk with your doctor.

Zomig and vaccines

There aren’t any known interactions between Zomig and vaccines. You can talk with your doctor or pharmacist to see whether you’re due for any vaccines.

Zomig and lab tests

Zomig isn’t known to interact with any lab tests. If you have concerns about this medication interacting with lab tests, talk with your doctor.

ZOMIG AND CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been reported to interact with Zomig. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Zomig. The impact of cannabis may affect how well you stick to your Zomig treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Zomig. Before you take this drug, be sure to talk with your doctor about your health history. Zomig may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Zomig include:

Ischemic bowel disease: Doctors typically will not prescribe Zomig for people with ischemic bowel disease. For details about this, see the “When to avoid Zomig” section above.

Basilar or hemiplegic migraine: Doctors typically will not prescribe Zomig for people with basilar or hemiplegic migraine. To learn more, see the “When to avoid Zomig” section above.

Certain cardiovascular conditions or related factors: Doctors typically will not prescribe Zomig for people with certain cardiovascular conditions, including stroke and peripheral vascular disease. To learn more about this, see the “When to avoid Zomig” section above.

Also, certain factors may increase your risk of heart problems as a side effect of Zomig. Examples include type 1 or type 2 diabetes, obesity, and smoking. Your doctor can review your health history and recommend whether it’s safe to take Zomig.

Liver problems: Before taking Zomig, tell your doctor if you have a liver problem, such as liver failure. Having a liver problem could increase Zomig levels in your system, increasing your risk of side effects. To reduce this risk, your doctor may prescribe a lower Zomig dosage.

Allergic reaction: If you’ve had an allergic reaction to Zomig or any of its ingredients, your doctor will likely not prescribe Zomig. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Breastfeeding: It’s not known whether it’s safe to take Zomig while breastfeeding. There isn’t enough information to determine whether the drug passes into breast milk or what effects Zomig may have on a child who is breastfed.

If you’re breastfeeding or planning to, talk with your doctor before taking Zomig. They can talk with you about treatment options and ways to feed your child.

Pregnancy: There haven’t been enough clinical trials to determine whether Zomig is safe to take while pregnant. Animal studies show that the drug may cause congenital anomalies (commonly known as birth defects). However, animal studies don’t always indicate what may happen in humans.

If you’re pregnant or planning to become pregnant, tell your doctor before starting Zomig. They can advise you on the right treatment plan for you.

Here are some frequently asked questions about Zomig and possible interactions.

Can I take zolmitriptan and ibuprofen together?

Yes, you can take zolmitriptan (Zomig) and ibuprofen (Advil, Motrin) together if your doctor recommends it. There are no reports of Zomig interacting with ibuprofen.

Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, may be used as rescue treatments for migraine. Rescue treatments are taken for migraine symptoms that are not relieved by migraine medications, including Zomig.

If you have other questions about taking Zomig with ibuprofen, talk with your doctor or pharmacist.

Is it safe to take Zomig with medications that help prevent migraine episodes?

In general, yes, it’s safe to take Zomig with migraine prevention drugs. Zomig is used to treat migraine episodes, but doctors may prescribe it with drugs that help prevent them.

That said, Zomig may interact with specific drugs for migraine prevention. Examples include tricyclic antidepressants (TCAs) and propranolol (Hemangeol, Innopran XL, others). To learn more about these interactions, see the “Drug interactions in depth” section above.

If you have other questions about taking Zomig with migraine prevention drugs, talk with your doctor or pharmacist.

You can take certain steps to help prevent interactions with Zomig. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Zomig label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Zomig doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Zomig by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Zomig. These resources might help:

• Overview of Zomig: For a general overview of Zomig, you can see this article.
• Side effects: If you’re interested in the side effects of Zomig, see this article. Another option is to refer to the Zomig prescribing information.
• Dosage specifics: To learn about the dosage of Zomig, see this article.
• Facts about migraine: To learn more about migraine, see our headache and migraine hub.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.