lCONTRA-INDICATIONSArrhythmias associated with
accessory cardiac conduction pathways.ischaemic heart
disease.peripheral vascular disease.previous
cerebrovascular accident.transient ischaemic attack.
uncontrolled hypertension.vasospasm.Wolff-Parkinson-
White syndrome
lCAUTIONSShould not be taken within 24 hours of any
other 5 HT 1 -receptor agonist
lINTERACTIONS→Appendix 1 : zolmitriptan
lSIDE-EFFECTS
GENERAL SIDE-EFFECTS
▶Common or very commonAbdominal pain.asthenia.chest
discomfort.dizziness.drowsiness.dry mouth.dysphagia
.feeling hot.headache.limb discomfort.muscle
weakness.nausea.pain.palpitations.sensation
abnormal.vomiting
▶UncommonTachycardia.urinary disorders
▶Rare or very rareAngina pectoris.angioedema.coronary
vasospasm.gastrointestinal disorders.gastrointestinal
infarction.hypersensitivity.myocardial infarction.
splenic infarction.urticaria
SPECIFIC SIDE-EFFECTS
▶Common or very common
▶With intranasal useFeeling abnormal.haemorrhage.
myalgia.nasal discomfort.taste altered.throat pain
▶With oral useMuscle complaints.sensation of pressure.
throat complaints
▶Rare or very rare
▶With oral useDiarrhoea
SIDE-EFFECTS, FURTHER INFORMATIONDiscontinue if
symptoms of heat, heaviness, pressure or tightness
(including throat and chest) occur.lPREGNANCYThere is limited experience of using 5 HT 1 -
receptor agonists during pregnancy; manufacturers advise
that they should be avoided unless the potential benefit
outweighs the risk.
lBREAST FEEDINGUse with caution—present in milk in
animalstudies.
lHEPATIC IMPAIRMENT
Dose adjustmentsMax. 5 mg in 24 hours in moderate or
severe impairment.
lDIRECTIONS FOR ADMINISTRATIONZolmitriptan
orodispersible tablets should be placed on the tongue,
allowed to disperse and swallowed.
lPATIENT AND CARER ADVICEPatients or carers should be
given advice on how to administer zolmitriptan
orodispersible tablets.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Spray
▶Zomig(AstraZeneca UK Ltd)
Zolmitriptan 50 mg per 1 mlZomig 5 mg/ 0. 1 ml nasal spray 0. 1 ml
unit dose| 6 unit doseP£ 36. 50 DT = £ 36. 50
Orodispersible tablet
EXCIPIENTS:May contain Aspartame
▶Zolmitriptan (Non-proprietary)
Zolmitriptan 2.5 mgZolmitriptan 2. 5 mg orodispersible tablets sugar
free sugar-free| 6 tabletP£ 20. 35 DT = £ 14. 84
Zolmitriptan 5 mgZolmitriptan 5 mg orodispersible tablets sugar
free sugar-free| 6 tabletP£ 20. 35 DT = £ 13. 79
▶Zomig Rapimelt(AstraZeneca UK Ltd)
Zolmitriptan 2.5 mgZomig Rapimelt 2. 5 mg orodispersible tablets
sugar-free| 6 tabletP£ 23. 99 DT = £ 14. 84
Zolmitriptan 5 mgZomig Rapimelt 5 mg orodispersible tablets sugar-
free| 6 tabletP£ 23. 94 DT = £ 13. 79
Tablet
▶Zolmitriptan (Non-proprietary)
Zolmitriptan 2.5 mgZolmitriptan 2. 5 mg tablets| 6 tabletP
£ 15. 78 DT = £ 15. 78 | 12 tabletP£ 31. 56
Zolmitriptan 5 mgZolmitriptan 5 mg tablets| 6 tabletP£ 3. 60
DT = £ 3. 60 | 12 tabletP£ 7. 20
▶Zomig(AstraZeneca UK Ltd)
Zolmitriptan 2.5 mgZomig 2. 5 mg tablets| 6 tabletP£ 23. 94 DT
=£ 15. 785.2 Neuropathic pain
Neuropathic pain
Overview and management
Neuropathic pain, which occurs as a result of damage to
neural tissue, includescompression neuropathies,peripheral
neuropathies(e.g. due to Diabetic complications p. 449 ,HIV
infection p. 409 , chemotherapy),trauma,idiopathic
neuropathy,central pain(e.g. pain following spinal cord
injury and syringomyelia),postherpetic neuralgia, and
phantom limb pain. The pain may occur in an area of sensory
deficit and may be described as burning, shooting or
scalding; it may be accompanied by pain that is evoked by a
nonnoxious stimulus (allodynia).
Children with chronic neuropathic pain require
multidisciplinary management, which may include
physiotherapy and psychological support. Neuropathic pain
is generally managed with atricyclic antidepressantsuch
as amitriptyline hydrochloride p. 238 orantiepileptic drugs
such as carbamazepine p. 196. Children with localised pain
may benefit fromtopical local anaestheticpreparations,
particularly while awaiting specialist review. Neuropathic
pain may respond only partially toopioid analgesics.A
corticosteroid may help to relieve pressure in compression
neuropathy and thereby reduce pain.
Chronic facial pain
Chronic oral and facial pain includingpersistent idiopathic
facial pain(also termed‘atypical facial pain’) and
temporomandibular dysfunction(previously termed
temporomandibular joint pain dysfunction syndrome) may
call for prolonged use of analgesics or for other drugs.
Tricyclic antidepressantsmay be useful for facial pain
[unlicensed indication], but are not on the Dental
Practitioners’List. Disorders of this type require specialist
referral and psychological support to accompany drug
treatment. Children on long-term therapy need to be
monitored both for progress and for side-effects.6 Sleep disorders
6.1 Insomnia
Hypnotics and anxiolytics
Overview
Most anxiolytics (‘sedatives’) will induce sleep when given at
night and most hypnotics will sedate when given during the
day. Hypnotics and anxiolytics should be reserved for short
courses to alleviate acute conditions after causal factors have
been established.
The role of drug therapy in the management of anxiety
disorders in children and adolescents is uncertain; drug
therapy should be initiated only by specialists after
psychosocial interventions have failed. Benzodiazepines and
tricyclic antidepressants have been used but adverse effects
may be problematic.Hypnotics
The prescribing of hypnotics to children, except for
occasional use such as for sedation for procedures is notBNFC 2018 – 2019 Insomnia 293
Nervous system4