Using Zavzpret Nasal Spray for Migraines
Medically reviewed by Erika Prouty, PharmD
Migraine can be a debilitating, disabling disease that, for many people, drastically affects their quality of life.
Fortunately, pharmaceutical solutions exist to manage migraine symptoms. One such treatment is Zavzpret (zavegepant), a brand-name nasal spray medication for migraine episodes.
In March 2023, the Food and Drug Administration (FDA) approved it to treat migraines. Availability to the public was scheduled for July 2023, according to the drug’s manufacturer.
Read on for more information about Zavzpret, including a review of its efficacy, its potential for side effects, dosing instructions, drug interactions, storage information, and more.
What Is Migraine?
The World Health Organization (WHO) lists migraine as one of the world's ten most disabling medical illnesses.
Migraine is a chronic neurological condition that causes recurring headaches and other symptoms. A migraine headache or episode is also called an acute migraine.
Migraine affects up to one in six Americans. Specifically, females are more likely to experience migraine headaches than males. Also, the incidence of migraine is higher in individuals ages 18 to 44 than in any other age group.
Migraine episodes can occur with or without an aura. An aura is a disturbance in the senses that occurs before the onset of a migraine attack.
For example, you might have vision problems or sensitivity to light in the days or hours before acute migraine (severe and rapid in onset) symptoms begin.
Acute migraine symptoms commonly include:
Severe pain, usually on one side of your head
Sensitivity to sound
Photophobia (sensitivity to light)
Healthcare providers rank the severity of acute migraine episodes as grade 1 through grade 4, depending on how much your symptoms affect your normal daily activities.
A grade 1 migraine may result in little change to your everyday activities, while a grade 4 episode may render you unable to work or complete daily tasks.
Several treatment options are available to treat migraine. One of the newest options is Zavzpret (zavegepant).
How Does Zavzpret Work?
Zavzpret contains the active ingredient zavegepant.
Zavzpret works by limiting the release of calcitonin gene-related peptides (CGRP) in the brain. This results in less pain signaling in the brain during a migraine attack, helping to relieve symptoms.
Zavzpret belongs to a class of medications called calcitonin gene-related peptide (CGRP) inhibitors.
These drugs limit the release of CGRP in the brain. CGRP is responsible for several actions, including the delivery of pain signals to nerves in the brain.
Using Zavzpret or other CGRP inhibitors releases fewer pain signals, which helps to ease the pain in migraine headaches. Zavzpret can also relieve other acute migraine symptoms, such as nausea and sensitivity to light or noise.
The FDA has approved Zavzpret for adults to treat migraine episodes with or without an aura.
Note that Zavzpret is only FDA-approved to treat an active migraine episode. This medication is not approved to prevent migraine headaches.
How Well Does Zavzpret Work?
Zavzpret received FDA approval for treating acute migraines following two major clinical trials assessing the drug's effectiveness, as follows:
In both studies, participants received either Zavzpret or a placebo nasal spray and were instructed to take the medication at the onset of acute migraine.
Study 1 demonstrated significant relief from pain and other bothersome migraine symptoms with Zavzpret compared to a placebo.
In this study, 24% of participants who took Zavzpret were pain-free two hours following administration, while only 15% of those who took a placebo experienced relief after two hours.
Study 2 showed similar effectiveness of Zavzpret for relieving pain and other migraine symptoms. Participants receiving Zavzpret experienced relief from their most bothersome symptom 42% of the time, compared to 34% of placebo users.
Zavzpret’s active ingredient gets absorbed directly through the cells in the nasal cavity, so it starts working quickly. Zavzpret should provide symptom relief within 30 minutes to two hours after administration.
Who Should Use Zavzpret?
Zavzpret is a nasal spray medication. Nasal sprays start working faster than drugs taken by mouth, such as tablets and capsules.
Zavzpret is prescribed to treat migraine episodes with or without an aura in adults. Note that Zavzpret is only used to treat active migraine episodes.
Zavzpret will not prevent migraine headaches and benefit people seeking a medicine that contains them.
Zavzpret, however, is a promising treatment option for adults with moderate to severe migraines who are comfortable using a nasal spray.
Some people experience symptoms during a migraine attack that make it difficult to swallow pills, such as nausea and vomiting.
A 2019 review of treatment options found that migraine nasal sprays, like Zavzpret, may be more effective than oral medications at treating rapid-onset migraines with maximum pain and migraines with nausea and vomiting.
One potential drawback to Zavzpret is that the recommended limit for Zavzpret is eight uses per month.
Therefore, it may not be the best choice for people who experience more frequent migraine headaches.
Side Effects & Safety
Zavzpret commonly causes the following side effects:
Changes in your sense of taste or temporary loss of taste
Nasal Discomfort
In rare cases, Zavzpret may cause severe allergic reactions, including facial swelling or hives. No other serious side effects have been reported with Zavzpret.
Zavzpret isn’t known to cause any long-term side effects.
However, frequent or long-term use of Zavzpret may increase the risk of nasal discomfort and taste changes. In studies, these side effects went away after the medication was stopped.
Zavzpret should not be used by people with a history of allergic reactions to its ingredients, including zavegepant. This medication is not recommended in people with severe liver or kidney problems.
The FDA approved Zavzpret for adults only (18 and older). It isn’t known if Zavzpret is safe to use in children. Its safety is also unknown regarding pregnant or breastfeeding people. These individuals should avoid use.
Before starting Zavzpret, talk to a healthcare provider about other medications you take. This will ensure Zavzpret is a safe and appropriate treatment option for you.
How to Use Zavzpret
Zavzpret is a nasal spray medication. Each spray provides one dose of 10 milligrams (mg) of zavegepant. The maximum dose of Zavzpret is 10 mg (one spray) in 24 hours.
When an acute migraine occurs, you’ll only administer Zavzpret by spraying one dose into one nostril. The drug comes with detailed instructions showing you how to use it.
Do not test or prime the nasal spray device before its time for use, as Zavzpret contains just a single dose.
In clinical trials that looked at the safety and efficacy of Zavzpret, the drug was safely used up to eight times per month.
It isn’t known if using Zavzpret to treat more than eight acute migraines per month is safe. Consider using a journal, calendar, or migraine app to keep track of your migraine days and treatments.
In Zavzpret’s clinical trials, the drug was shown to be effective in treating an acute migraine within two hours or less after taking a dose.
Some people may notice symptoms easing, including reduced pain and other migraine symptoms, within 30 minutes.
Zavzpret Interactions
Certain medications interact with Zavzpret and can change how your body processes Zavzpret.
Drug interactions can lead to severe side effects or may cause medications to be less effective treatments.
Drugs that interact with Zavzpret include:
Intranasal decongestants: Intranasal decongestions—those sprayed into the nose—might reduce the absorption of Zavzpret, which could make the drug less effective.
Many oral and nasal decongestants are available over the counter (OTC) or by prescription that will not interfere with how Zavzpret works.
Examples are:
Zyrtec D 12-Hour (cetirizine/pseudoephedrine)
Sudafed 24-Hour (pseudoephedrine)
If you need to use a nasal decongestant, take it at least one hour after using Zavzpret.
Drugs that inhibit (block) proteins in the body are called OATP1B3 or CYP3A4 inhibitors: These drugs may increase the risk or severity of side effects from Zavzpret.
Examples are:
Gengraf (cyclosporine)
Rifadin (rifampicin)
Actos (pioglitazone)
Drugs that induce (enhance) OATP1B3 or NTCP may make Zavzpret less effective for treating acute migraine.
Examples are:
Mycelex (clotrimazole)
Prometrium (progesterone)
Summary
While migraines can be complicated to manage, solutions are available to relieve symptoms.
Zavzpret is a single-dose nasal spray approved by the FDA in 2023 to treat acute migraine in adults. It does not prevent migraine headaches.
Clinical trials of the drug demonstrated its effectiveness in relieving migraine episodes, typically within 30 minutes to two hours. Zavzpret is well-tolerated by most people.
However, like most drugs, Zavzpret carries the risk of side effects, including taste changes, nausea, nasal discomfort, vomiting, and allergic reactions.
Talk to your healthcare provider to determine the best approaches for preventing and treating migraine that are right for you.
Frequently Asked Questions
How do I store Zavzpret?
Store Zavzpret at room temperature. Avoid storing Zavzpret in areas with rapid changes in temperature, such as a window sill. Keep it out of reach of children and pets.
Can lifestyle changes help my migraines?
Yes, lifestyle changes may help reduce migraine frequency and severity. The first step is determining what your migraine triggers are. Common triggers are stress, certain foods or beverages like red wine, sleeping too little or too much, weather changes, or physical activity.
Consider keeping track of possible triggers, such as what you ate or did, before each migraine.
Once you know your triggers, you can make lifestyle changes to avoid or limit them. Getting consistent sleep leads to fewer or less severe migraines for many people.
How much does Zavzpret cost?
Pricing for Zavzpret, available in pharmacies in July 2023, will be established at that time.
However, Zavzpret is expected to be priced similarly to other brand-name CGRP inhibitors that treat migraine. These include Nurtec ODT (rimegepant) and Ubrelvy (ubrogepant), whose manufacturers offer co-pay cards or patient-assistance programs to help defray costs.
