Zavzpret (Zavegepant)

Zavzpret (zavegepant) is a nasal spray medication for the acute treatment of migraine with or without aura in adults. It's a CGRP (calcitonin gene-related peptide) receptor antagonist, part of a newer class of migraine-specific treatments.

How It Works

CGRP plays a key role in migraine:

• Released during migraine attacks
• Causes blood vessel dilation and inflammation
• Sensitizes pain pathways

Zavzpret blocks CGRP receptors:

• Prevents CGRP from activating receptors
• Reduces migraine-related inflammation
• Relieves headache and associated symptoms

Common Uses

• Acute treatment of migraine attacks
• Migraine with or without aura
• When triptans are contraindicated or ineffective
• Alternative to oral medications (especially with nausea)

How to Use

• Dosing: One spray (10 mg) in one nostril
• Timing: Use at migraine onset or any time during attack
• Maximum: One dose per 24 hours
• Technique: Prime if first use or not used in 7 days; spray while breathing in gently

Administration Steps

1. Prime the spray if needed (press until spray appears)
2. Blow nose gently if congested
3. Insert nozzle into one nostril
4. Close other nostril with finger
5. Press down firmly and breathe in gently through nose
6. Breathe out through mouth

What to Expect

During Attack

• Relief may begin within hours
• Addresses headache and associated symptoms
• May not eliminate attack completely in all patients

Response Rates

Clinical trials showed:

• Significant pain relief at 2 hours
• Many patients pain-free at 2 hours
• Also improved nausea, light sensitivity, sound sensitivity

Side Effects

Common

• Taste disturbance (dysgeusia)—most common
• Nasal discomfort
• Nausea
• Throat irritation

Less Common

• Nasal congestion
• Vomiting
• Dizziness

Generally Well-Tolerated

• No cardiovascular contraindications like triptans
• Side effects usually mild and transient

Advantages of Zavzpret

Vs. Triptans

• No vasoconstrictive effects
• Can use with cardiovascular disease
• Can use with uncontrolled hypertension
• Alternative mechanism if triptans fail

Nasal Spray Benefits

• Bypasses GI tract (helpful with migraine-related nausea)
• Faster absorption than oral medications
• Useful when vomiting prevents oral medication

Precautions

• Pregnancy: Limited data; discuss with doctor
• Breastfeeding: Unknown if excreted in milk
• Severe hepatic impairment: Not recommended
• Drug interactions: Check with pharmacist

Zavzpret vs. Other Acute Migraine Treatments

Class	Examples	Notes
CGRP antagonists	Zavzpret, Nurtec	New class, no vascular effects
Triptans	Sumatriptan, rizatriptan	First-line, cardiovascular cautions
NSAIDs	Ibuprofen, naproxen	OTC, less migraine-specific
Ditans	Lasmiditan	Different mechanism, causes sedation

CGRP Medications Landscape

Medication	Type	Use
Zavzpret	Nasal spray	Acute treatment
Nurtec	Oral	Acute + prevention
Ubrelvy	Oral	Acute treatment
Aimovig, Ajovy, Emgality	Injection	Prevention

Cost and Insurance

• Brand-name medication
• May require prior authorization
• Check manufacturer savings programs
• Coverage varies by plan

Frequently Asked Questions

How is Zavzpret different from triptans?

Triptans cause blood vessel constriction, which is why they're contraindicated in cardiovascular disease. Zavzpret works by blocking CGRP without affecting blood vessels, making it an option for patients who can't use triptans.

Can I use Zavzpret if I have heart disease?

Unlike triptans, Zavzpret doesn't have cardiovascular contraindications. However, discuss your complete medical history with your doctor.

Why does it affect my taste?

The CGRP receptor is present in taste-related pathways. Taste disturbance is the most common side effect but is temporary.

Can I use Zavzpret for every migraine?

Yes, one dose can be used per migraine attack (maximum once in 24 hours). However, if you're having frequent migraines, preventive therapy should be discussed.

What if one spray doesn't work?

Don't take a second dose within 24 hours. If Zavzpret consistently doesn't help, discuss alternatives with your doctor.

Can I use Zavzpret and Nurtec together?

Both are CGRP antagonists. Using them together isn't typically recommended. Discuss with your doctor if one isn't sufficient.