Section 02 · Monograph
Zavegepant
Reviewed Nov 2026FDA label
ZavzpretGepant · intranasal
- Forms
- NS: 10mg/spray
- Dose
- 10mg intranasal PRN
- MOA
- CGRP receptor antagonist
Indications
- Acute treatment of migraine with or without aura in adultsFDA-labeled
- Not indicated for the preventive treatment of migraineFDA-labeled
Mechanism of Action
- Small-molecule calcitonin gene-related peptide (CGRP) receptor antagonist ("gepant") formulated as an intranasal spray
- Antagonizes CGRP receptors to block neurogenic inflammation and vasodilation implicated in migraine pathophysiology
- Intranasal delivery provides rapid absorption, enabling faster onset of action than oral gepants — useful for patients with migraine-associated nausea/vomiting limiting oral intake
Full Dosing
Adult / usual
- Recommended dose: 10 mg administered as a single spray in one nostril, as needed
- Maximum dose: 10 mg (one spray) in a 24-hour period
- Safety of treating more than 8 migraine attacks per month has not been established
Renal
- Renal impairment: no dosage adjustment needed if creatinine clearance ≥30 mL/min; avoid use if CLcr <30 mL/min or in end-stage renal disease
Hepatic
- Hepatic impairment: no adjustment needed for mild (Child-Pugh A) or moderate (Child-Pugh B) impairment; avoid use in severe impairment (Child-Pugh C)
Contraindications
- History of hypersensitivity reaction to zavegepant or any component of Zavzpret, including reported cases of anaphylaxis
Drug Interactions
- No clinically relevant interaction observed with strong CYP3A4 inhibitors (e.g., itraconazole) based on studies conducted
- OATP1B3/NTCP inhibitors and inducers: avoid concomitant use — can significantly alter zavegepant systemic exposure
- Intranasal decongestants (e.g., oxymetazoline): avoid concurrent use, or separate administration by at least 1 hour, as they may reduce zavegepant absorption/efficacy
Adverse Effects
- Taste disorders/dysgeusia (most common, ~18%)
- Nausea (~4%)
- Nasal discomfort (~3%)
- Vomiting (~2%)
- Hypersensitivity reactions, including anaphylaxis
- Postmarketing: hypertension (new onset or worsening)
- Postmarketing: Raynaud's phenomenon
Monitoring Parameters
- Monitor for hypersensitivity reactions, which can occur even after prior tolerated doses
- Assess nasal mucosal tolerability with repeated use
- Monitor frequency of use to avoid medication-overuse headache
- Assess renal function; avoid use if CLcr <30 mL/min
- Monitor blood pressure for new-onset or worsening hypertension
Pregnancy & Lactation
- Pregnancy: No adequate human data on drug-associated risk; animal reproduction studies did not show adverse fetal effects at clinically relevant exposures
- Lactation: No data on the presence of zavegepant in human milk or its effects on the breastfed infant or milk production
- Consider the developmental and health benefits of breastfeeding along with the mother's clinical need for zavegepant and any potential adverse effects on the breastfed infant