9 Things to Know About Zavzpret: A New Nasal Spray for Migraine Treatment
Key takeaways:
Zavzpret (zavegepant) is a prescription nasal spray that can treat adults with acute migraines. The FDA first approved it in March 2023.
This medication is the first calcitonin gene-related peptide (CGRP) receptor antagonist to be available as a nasal spray. Other CGRP blockers are available as pills and injections.
Zavzpret is generally well tolerated, but can cause side effects such as changes in taste, nasal discomfort, and nausea.
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One minute you're going about your daily life, and the next you start feeling nauseous, having vision changes, and developing a painful headache. You recognize these symptoms: a migraine is about to hijack your day. The pain and discomfort can be unpredictable and debilitating, so it’s a priority to get fast relief.
Zavzpret (zavegepant) is one option you can turn to. It’s a relatively new medication that can treat adults with acute migraines. But unlike many other medications, it’s not a pill you take by mouth. It's actually a nasal spray, which means it can work quickly. And it's expected to be available in pharmacies by July 2023.
Below, we’ll answer nine common questions on how Zavzpret works, how effective it is at treating migraines, and if it might be a viable treatment option for you.
1. What does Zavzpret treat?
Zavzpret (zavegepant) treats migraine headaches. It was FDA approved in March 2023 for the treatment of acute migraines with or without aura in adults. An aura refers to accompanying symptoms of vision changes, facial or body tingling, or trouble speaking.
Good to know: Zavzpret is meant for acute migraines. It’s only intended to be used after a migraine starts. It can’t prevent migraines.
2. How does Zavzpret work?
Zavzpret is a calcitonin gene-related peptide (CGRP) receptor antagonist. This means it works by indirectly blocking CGRP, which is a protein that carries pain signals along nerves that cause headache pain. By blocking this protein, Zavzpret can help improve migraine symptoms.
But Zavzpret isn’t the only CGRP blocker. CGRP drugs have been around for several years. Oral CGRP drugs (“gepants”) are one group; they also treat acute migraines. Ubrelvy (ubrogepant) and Nurtec ODT (rimegepant) are two examples. Other CGRP drugs, like Aimovig (erenumab), Emgality (galcanezumab), and Ajovy (fremanezumab), are available as under-the-skin injections. But they’re only approved for migraine prevention.
Zavzpret is unique because of how it’s given. Zavzpret is administered into the nose as a nasal spray. It generally provides faster pain relief than most medications that are taken by mouth.
3. Is Zavzpret a triptan?
No, Zavzpret is not a triptan. Zavzpret is a CGRP blocker that works most similarly to Ubrelvy and Nurtec ODT.
Triptans are some of the most common medications used for migraine relief. They include medications like sumatriptan (Imitrex), zolmitriptan (Zomig), and rizatriptan (Maxalt). They come as tablets, nasal sprays, and under-the-skin injections.
All triptans work by affecting serotonin receptors (chemical binding sites) in the brain, which helps lower blood vessel swelling that causes migraine pain. They can also disrupt pain signaling from your nerves.
4. How do you use Zavzpret?
Zavzpret nasal spray is administered as needed for acute migraines. The recommended dose is one 10 mg spray into one nostril. You shouldn't administer more than one spray in a 24-hour period.
Before administering Zavzpret, blow your nose to make sure it’s as clear as possible. Then, close one nostril with your finger while inserting Zavzpret’s nozzle into your other nostril. Keep your head level while delivering the nasal spray and gently breathe in with your mouth closed. You shouldn’t lay down or tilt your head while you’re actively delivering the spray.
Each Zavzpret device only contains 1 spray, and it can't be reused. So don't try priming or testing the spray before using it. You’ll lose the dose if you do.
5. How long does it take Zavzpret to work?
Zavzpret works quickly to treat acute migraines. It's rapidly absorbed through the nose. A clinical trial found that Zavzpret provided pain relief in as little as 15 minutes. Plus, many people were able to shake off most of their symptoms within 30 minutes to 2 hours of taking a dose.
This means that Zavzpret works about as quickly as rizatriptan (the fastest-working triptan that’s taken by mouth), which provides migraine relief in about 30 minutes. Sumatriptan nasal spray (Tosymra) can start working in as little as 10 minutes, but it can take up to 2 hours to provide full migraine relief. Medications like Nurtec ODT also can take up to 2 hours.
6. Is Zavzpret effective at treating migraines?
In general, yes. In the same study mentioned above, more people taking Zavzpret had freedom from migraine pain compared to placebo (a spray with nothing in it). This relief often lasted for up to 2 days.
But migraines are more than just a bad headache. Some people in the study reported their “most bothersome migraine symptom” as either sensitivity to light, sensitivity to sound, or nausea. A greater number of people had relief from their most bothersome symptom within 2 hours of their dose when taking Zavzpret than those taking placebo.
Still, everyone’s experiences with migraines are different. Even though Zavzpret was considered effective in clinical trials, it may or may not be effective for you. Your healthcare provider can tell you if Zavzpret may be a good fit.
7. How long do you have to take Zavzpret?
It’s best to only use Zavzpret as needed — not to exceed one dose in a 24-hour period. You can use Zavzpret up to 8 times in a month. This averages out to about 2 times per week.
Speak with your healthcare provider if you have migraines more often than this. They can talk to you about other ways to get your symptoms under better control. In some cases, they may recommend a preventative migraine medication.
8. Is Zavzpret safe to take?
Yes, Zavzpret is considered safe to take. It was well tolerated in initial studies. The most common side effects were temporary changes in taste, which happened in about 18% of people who took Zavzpret. Other common side effects included nausea, vomiting, and nasal discomfort.
In rare cases, Zavzpret has been the culprit behind serious allergic reactions. But it hasn’t been linked to any other serious side effects so far.
9. Is Zavzpret better than other migraine medications?
Zavzpret hasn't been compared with other migraine medications in head-to-head studies. So we don't know if it's “better” than other migraine medications. But there may be some advantages to trying Zavzpret for your next migraine.
Dosage forms are a main consideration. Similar medications, like Ubrelvy and Nurtec ODT, are only available as oral tablets. If you have trouble swallowing pills or become nauseous during migraines, you may benefit from a nasal spray.
Risks and side effects are another factor. Zavzpret has fewer side effects than other common migraine medications, like triptans. This is because triptans can constrict blood vessels in the body. People who have a history of heart attacks, stroke, or coronary artery disease should generally avoid triptans. Zavzpret doesn't tighten blood vessels in the same way, so people with these heart-related health conditions can use it.
Plus, triptans can cause rebound headaches — also known as medication overuse headaches. These are headaches that can happen when you take headache medicine too often. Zavzpret wasn’t reported to cause rebound headaches in clinical trials.
Speak with your healthcare provider to see if Zavzpret may be a treatment option for you.
The bottom line
Zavzpret (zavegepant) is a prescription migraine medication for adults. It’s the first CGRP blocker that can be administered as a nasal spray. It was shown to be effective at providing fast and lasting migraine pain relief in adults. Zavzpret’s side effects appear to be minimal, but it can cause nausea, taste changes, and nasal discomfort.
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References
Lipton, R.B., et al. (2019). Rimegepant, an oral calcitonin gene–related peptide receptor antagonist, for migraine. The New England Journal of Medicine.
Lipton, R.B., et al. (2023). Safety, tolerability, and efficacy of zavegepant 10 mg nasal spray for the acute treatment of migraine in the USA: A phase 3, double-blind, randomised, placebo-controlled multicentre trial. The Lancet Neurology.
Nicolas, S., et al. (2022). Triptans. StatPearls.
Noor, N., et al. (2022). A comprehensive review of zavegepant as abortive treatment for migraine. Health Psychology Research.
Pfizer, Inc. (2023). Zavzpret [package insert].
Pfizer. (2023). Pfizer’s ZAVZPRET™ (zavegepant) migraine nasal spray receives FDA approval.
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