Zomig Drug Interactions: What to Avoid and What to Tell Your Doctor

Zomig (zolmitriptan) has a number of important drug interactions that you need to know about before taking it. Some are absolute contraindications—medications you must never combine with Zomig. Others require caution and monitoring. Here's a complete, patient-friendly guide.

Absolute Contraindications — Never Combine with Zomig

These combinations are contraindicated—meaning you should not take Zomig if you are using these medications:

MAO Inhibitors (MAOIs)

MAO-A inhibitors significantly increase zolmitriptan blood levels—up to 3 times—and can trigger dangerous serotonin syndrome. Do not take Zomig within 2 weeks of using any MAO inhibitor. This includes:

Phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan) — traditional MAOIs used for depression

Linezolid (Zyvox) — an antibiotic with MAO-inhibiting properties

Methylene blue injection — used in some medical procedures

Other Triptans

Do not take Zomig within 24 hours of another triptan (sumatriptan/Imitrex, rizatriptan/Maxalt, eletriptan/Relpax, naratriptan/Amerge, etc.). Combining triptans can cause additive vasospasm—dangerous narrowing of blood vessels that can lead to heart attack or stroke.

Ergotamine and Ergot-Type Medications

Do not use Zomig within 24 hours of ergotamine or ergot-type medications. These include:

Ergotamine (Ergomar, Cafergot)

Dihydroergotamine (D.H.E. 45, Migranal, Trudhesa)

Methysergide (rarely used, but still prescribed)

Combining ergot-type drugs with Zomig increases the risk of prolonged vasospasm, which can cause peripheral vascular ischemia or cardiac events.

Significant Interactions — Use With Caution

SSRIs and SNRIs (Antidepressants)

Taking Zomig with SSRIs or SNRIs can increase serotonin levels to dangerous levels—a condition called serotonin syndrome. SSRIs include fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa). SNRIs include venlafaxine (Effexor) and duloxetine (Cymbalta).

The combination is not absolutely contraindicated but requires caution and monitoring. Tell your doctor if you take any antidepressants, and watch for symptoms of serotonin syndrome: agitation, confusion, fever, rapid heart rate, muscle twitching, and loss of coordination.

Cimetidine (Tagamet)

Cimetidine, an over-the-counter antacid/H2 blocker (Tagamet), approximately doubles the blood levels of zolmitriptan and its active metabolite by inhibiting the liver enzyme that breaks it down. If you take cimetidine, limit Zomig to a maximum of 2.5 mg per dose and no more than 5 mg in 24 hours.

Propranolol

Propranolol (a beta-blocker commonly used for migraine prevention) increases zolmitriptan blood levels by approximately 1.5-fold. This interaction doesn't necessarily mean you can't use both—many patients take propranolol for migraine prevention and use triptans for acute attacks—but your doctor should know and may adjust your dose.

Oral Contraceptives

Women taking oral contraceptives may have 30-50% higher zolmitriptan blood levels (increased Cmax and AUC). This is generally well-tolerated, but it's something your prescriber should know about when determining the right starting dose.

What to Tell Your Doctor Before Starting Zomig

Before taking Zomig, make sure your doctor or pharmacist knows about:

All antidepressants (SSRIs, SNRIs, TCAs, MAOIs)

Any other triptan or ergot migraine medications

Cimetidine (Tagamet) — even OTC versions

Beta-blockers like propranolol

Birth control pills or hormonal contraceptives

Any heart or blood pressure medications

Herbal supplements including St. John's Wort (serotonin syndrome risk)

Related: Zomig Side Effects: What to Expect and When to Call Your Doctor

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