Which patient profile is most likely to be prescribed zolmitriptan for migraines?

• A. An 18-year-old female with BMI 25
• B. An 18-year-old male with BMI 30
• C. A 65-year-old male with coronary artery disease
• D. A 28-year-old female with BMI 24

Answer: (B)

Zolmitriptan is a triptan used for acute migraine that works by activating 5-HT1B/1D receptors to cause cranial vasoconstriction. Because of this vasoconstrictive effect, it is contraindicated in patients with cardiovascular disease, such as coronary artery disease, since it can provoke ischemia or vasospasm. Therefore, the profile with coronary artery disease is not suitable for zolmitriptan.

The other profiles do not list cardiovascular disease, so they are potential candidates. An 18-year-old adult is within the typical prescribing range for acute migraine therapy, and having a BMI of 30 (obesity) by itself does not exclude use of zolmitriptan. Thus, this profile is the best fit among the options for a patient who could be prescribed zolmitriptan.