Treating Acute Migraine With Zavzpret

7 min read

The approval of medicines called “CGRP antagonists” has led to big changes in how migraines are managed. These medicines work in a different way than older medicines to treat or prevent migraine. The first CGRP antagonists were only available as a shot, and they were only approved to prevent migraine. Zavzpret (zav-spret) was approved in 2023 as the first CGRP antagonist that comes as a nasal spray. It is approved to treat acute migraine attacks with or without aura. 

Migraine is a condition where you have intense headaches, usually with throbbing pain on one side. The headache can come back again and again and may last for up to 72 hours. You may also have what is called an aura, where you have changes in your vision or other symptoms, such as numbness or trouble speaking.

The active ingredient in Zavzpret is zavegepant. You may also hear it called a “gepant.” It is a calcitonin gene-related peptide (CGRP) antagonist. CGRP is a protein that causes blood vessels to widen and can lead to pain and inflammation during a migraine. CGRP may also have a role in causing migraine. CGRP antagonists prevent CGRP from binding to its receptors and having its effects. Blocking CGRP can help relieve pain during a migraine attack.

Zavzpret comes as a 10-milligram nasal spray. You use a single spray in one nostril, as needed, for acute migraine. You should not use more than one spray within 24 hours. You should also not use more than eight doses in 30 days, since there are no studies to say whether this is safe.

Keep Zavzpret in its blister pack until you are ready to use it. The device only contains one spray, so you will lose your dose if you use a test spray, prime it, or press the plunger before you are ready to use it. You should only spray once into one nostril. 

Zavzpret should only be sprayed into the nose. Do not spray it into the eyes.

Blow your nose to clear your nostrils before using Zavzpret. Press one nostril closed, and insert the device into the open nostril as much as you can comfortably. Keep your head level and do not tilt your head or lie down when using the nasal spray. 

To get your dose, slowly breathe in through your nose while firmly pressing the plunger once with your thumb. Keep the nozzle in your nose until the plunger is firmly pressed. Once you have used your dose, remove the nozzle and breathe in through your nose and out through your mouth for 10 to 20 seconds, keeping your head level. If the medicine drips out, gently sniff to avoid losing any of your dose. Throw out the device after you use it. 

The drugmaker’s website has a video that shows you how to use and store Zavzpret.

Two studies were done to see if a single dose of Zavzpret was effective, compared to a placebo containing no medicine. People in the studies did not know if they were getting Zavzpret or the placebo. Efficacy was measured by the percentage of adults who were pain-free and free of their most bothersome migraine symptom (nausea or sensitivity to light or sound) 2 hours after their dose.

In both studies, people were told to treat their migraine if they had moderate to severe pain. If needed, they could take a “rescue” medicine (such as acetaminophen, ibuprofen, or an anti-nausea medicine) 2 hours later. They could not take a triptan, such as sumatriptan (Imitrex and others), eletriptan (Relpax), or others, within 48 hours of their first treatment. 

About 13.5% of people in these studies were taking medicines to prevent migraine (such as amitriptyline, propranolol, or topiramate), but none were taking other medicines that affected CGRP. The studies included adults who had a history of migraines with or without aura for at least 1 year, had migraines usually lasting 4 to 72 hours, and had two to eight moderate to severe migraine attacks per month. About 83% of people in these studies were female, 81% were White, and the average age was 41 years.

A significantly higher percentage of people who used Zavzpret saw the benefits below, compared to people who used the placebo. 

  • Free of pain: Up to 23.6% of people who used Zavzpret were pain-free 2 hours after the dose, compared to up to 15.5% of people who used the placebo.
  • Free of the most bothersome migraine symptom (nausea or sensitivity to light or sound): Up to 41.9% of people who used Zavzpret were free of their most bothersome symptom 2 hours after the dose, compared to up to 33.7% of people who used the placebo.

The studies also looked at how many people continued to be pain-free 2 to 48 hours after their dose. Up to 12.4% of people using Zavzpret had no pain during this time frame, compared to up to 8.7% of people taking the placebo.

Your results may differ from what was seen in clinical studies.

You should start to see relief of migraine pain or other bothersome symptoms (such as nausea or sensitivity to light or sound) within 2 hours of using your dose of Zavzpret. Talk with your health care provider about what you should do if you still have symptoms 2 hours after your dose. Your health care provider may discuss options for “rescue” treatment, or they can discuss other options for treating acute migraine. Depending on how many migraines you have in a month, your health care provider may also discuss whether you should use a medicine to prevent migraines.

There are no studies to say whether it is safe to use Zavzpret to treat more than eight migraines in 30 days. Consider keeping a headache diary to keep track of when you have migraines and when you take your migraine medicines. This can help you and your health care provider find out how well your medicines are working for you.

The most common side effects are an unusual taste, nausea, discomfort in the nose, and vomiting. 

Be sure you understand how to use the nasal spray properly. Ask your pharmacist or other health care provider if you are not sure. 

An unusual taste could include a change in how things taste or a loss of taste. If you find that certain foods cause an unpleasant taste, you may want to temporarily avoid those foods and stick with simpler foods. Staying hydrated, good oral hygiene, and quitting smoking may also help prevent an unusual taste.

Nausea and vomiting are common symptoms that can happen with migraine in general. To help limit nausea or vomiting, you can try simple steps, like eating bland foods, such as toast or crackers, and avoiding strong smells, such as from cooking, perfume, or smoke. Your health care provider may also prescribe medicine to help reduce these symptoms if you commonly have nausea or vomiting during a migraine.

While not common, a severe allergic reaction may happen with Zavzpret. Stop using it and get help right away if you have symptoms of a serious allergic reaction, such as breathing problems; swelling of the face, lips, mouth, tongue, or throat; or a severe rash, itching, or hives. 

These are not all of the possible side effects. Talk with your health care provider if you are having symptoms that bother you. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

Zavzpret may interact with nasal spray decongestants, such as oxymetazoline (Afrin, Sinex, and others) or phenylephrine (Neo-Synephrine and others). You can buy these over the counter (OTC). Avoid using a nasal spray decongestant with Zavzpret, because the Zavzpret may be less absorbed and may not work as well. If you must use a nasal spray decongestant, wait at least 1 hour after using Zavzpret. Ask your health care provider about other options that may help with nasal congestion.

Ask your pharmacist or other health care provider if any of your medicines interact with Zavzpret. Several medicines can affect the blood levels of Zavzpret in your body. This may increase the risk of side effects or can cause it to not work as well. For this reason, Zavzpret should be avoided with certain medicines.

Tell your health care provider about all the prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, or other supplements you take or have recently taken. This will help them find out if there are any interactions with Zavzpret. Do not start or stop other medicines while using Zavzpret without talking to your health care provider.

You will need a prescription from a health care provider. Your primary care provider, neurologist, or a headache specialist may prescribe Zavzpret. You can get it at any pharmacy.

There is a copay card available from the drugmaker that may allow you to pay $0 for your prescription. Whether you are eligible depends on whether you have prescription insurance, and what type of insurance you have. You can find out more at www.zavzpret.com/how-to-get