Drug Interaction Report

Zolmitriptan and Dihydroergotamine Nasal Spray: Interaction Details

A pharmacist-reviewed analysis of the Zolmitriptan and Dihydroergotamine Nasal Spray interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Zolmitriptan

Zomig
+

Dihydroergotamine Nasal Spray

Migranal Migranal® Nasal Spray Trudhesa Trudhesa® Nasal Spray
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
LinkedIn
Interaction severity
Contraindicated
These should generally not be used together.
How we grade severity & evidence

Severity levels

  • Contraindicated: These should generally not be used together.
  • Major: Potentially serious — often needs a change or close monitoring.
  • Moderate: Can be significant — usually manageable with monitoring.
  • Minor: Usually limited clinical impact.

Evidence grades

  • Established: Well documented — supported by controlled studies or strong clinical data.
  • Probable: Good supporting evidence, though not definitively proven.
  • Suspected: Some evidence suggests this interaction, but it is not well established.
  • Possible: Limited or conflicting evidence; the interaction may occur.
  • Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.

Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.

Of 33 documented Zolmitriptan interactions, 4 are rated contraindicated — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
rapid
Evidence
probable
Severity
Contraindicated

What happens

Prolonged vasospastic reactions

Interaction Deep Dive

Based on the theory that prolonged vasospastic reactions may be additive with zolmitriptan and ergot derivatives, the use of zolmitriptan within 24 hours of an ergot-type agent is contraindicated3. One case has been reported where concurrent use of ergotamine and sumatriptan, another selective 5-hydroxytryptamine-1 receptor agonist, was associated with cerebellar infarction in a 24-year-old female with no evidence of vascular anomaly 1.

Why it happens (mechanism)

Additive vasoconstrictive effects

Literature reports

1 report — tap to read

a) In a double-blind, randomized, balanced, two-period study, 12 healthy volunteers were given either oral dihydroergotamine 5 mg or placebo twice a day for 10 days, with a washout of at least a week between periods. In addition, subjects were given zolmitriptan 10 mg on the morning of the last day of each period. No significant pharmacokinetic or pharmacodynamic interactions between zolmitriptan or dihydroergotamine were observed 2.

Common questions

Can I take Zolmitriptan and Dihydroergotamine Nasal Spray together?

Prolonged vasospastic reactions Always confirm with your pharmacist or prescriber before making any change.

How serious is the Zolmitriptan and Dihydroergotamine Nasal Spray interaction?

It is rated contraindicated. These should generally not be used together.

How quickly could this interaction happen?

The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.

How strong is the evidence for this interaction?

The evidence is graded "probable". Good supporting evidence, though not definitively proven.

Questions for your pharmacist

  • Does my dose of Zolmitriptan or Dihydroergotamine Nasal Spray need adjusting while I take them together?
  • What symptoms should prompt me to call you or my prescriber right away?
  • Does the timing of my doses matter for this combination?
  • Is there a safer alternative to one of these medications for me?

References (3)

  1. Anon: Cave ergotamin (Migrexa U.A.) plus sumatriptan (Imigran). Arznei-Telegramm 1994; 3/94:32.
  2. Veronese L, Gillotin C, Marion-Gallois R, et al: Lack of interaction between oral dihydroergotamine and the novel antimigraine compound zolmitriptan in healthy volunteers. Clin Drug Invest 1997; 14:217-220. DOI
  3. Product Information: Zomig(R), zolmitriptan. AstraZeneca Pharmaceuticals, Wilmington, DE, 2002. DailyMed
Was this write-up helpful?
Zolmitriptan

Keep reading about Zolmitriptan

All Zolmitriptan interactions (33)
Also serious with: Dihydroergotamine Injection Linezolid Injection Methylergonovine Palonosetron Injection
Dihydroergotamine Nasal Spray

Keep reading about Dihydroergotamine Nasal Spray

All Dihydroergotamine Nasal Spray interactions (157) Dihydroergotamine Nasal Spray drug information
Also serious with: Troleandomycin Tucatinib Voriconazole Vasopressin
Beyond drug–drug

These medications also interact with supplements

Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:

Zolmitriptan + Activated Charcoal American Hellebore Arsenic Cesium Ephedra Grapefruit Lithium Sida Cordifolia + 42 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

Check another combination

Our instant two-drug interaction checker is almost here.

Coming soon

The instant two-drug checker is on its way.

In the meantime, browse the directory below to look up any drug and see its documented interactions.

Still have questions about this combination?

Every question gets a real answer from a licensed pharmacist — free, and usually within a day.

Ask the pharmacist
This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.