Contraindications for Zavzpret (Zavegepant)
Zavegepant has no absolute contraindications listed in current evidence, making it a particularly safe option for acute migraine treatment, especially in patients with cardiovascular risk factors who cannot use triptans. 1, 2
Key Safety Profile
No cardiovascular contraindications exist - Unlike triptans, zavegepant does not cause vasoconstriction and can be safely used in patients with:
This represents a major clinical advantage, as triptans are explicitly contraindicated in these conditions. 3
Drug-Drug Interactions
Zavegepant can be safely coadministered with sumatriptan without clinically significant pharmacokinetic or pharmacodynamic interactions, including no effect on blood pressure. 4 The mean time-weighted average differences in blood pressure between zavegepant plus sumatriptan versus sumatriptan alone were negligible: 0.04 mmHg for mean arterial pressure, 0.00 mmHg for diastolic blood pressure, and 0.33 mmHg for systolic blood pressure. 4
No significant drug interactions have been identified in clinical trials, though comprehensive interaction studies are still limited. 1, 5
Pregnancy and Lactation Considerations
While not explicitly listed as a contraindication in the available evidence, standard precautions for pregnancy should apply as with most acute migraine medications. 3 The evidence does not provide specific pregnancy category information for zavegepant, unlike the detailed contraindication data available for triptans and other migraine medications. 3
Common Pitfalls to Avoid
Do not confuse zavegepant's safety profile with triptans - The most common error is unnecessarily avoiding zavegepant in patients with cardiovascular disease based on triptan contraindications. 1 Zavegepant's mechanism as a CGRP receptor antagonist does not involve vasoconstriction. 5
Dysgeusia (altered taste) is common but not a contraindication - Approximately 21% of patients experience dysgeusia versus 5% with placebo, but this is a tolerability issue rather than a safety concern. 2 This adverse effect should be discussed with patients but does not preclude use.
Nasal discomfort occurs in 5% of patients versus 1% with placebo, but again represents a tolerability rather than safety issue. 2
Clinical Context
The absence of cardiovascular contraindications makes zavegepant particularly valuable for:
- Patients with sudden-onset attacks requiring rapid relief 1
- Those with nausea or vomiting who cannot tolerate oral medications 1
- Patients with high cardiovascular risk burden who cannot use triptans 1
The intranasal formulation achieves median Tmax of 0.5 hours regardless of whether administered during a migraine attack or non-migraine period, providing consistent rapid absorption. 6