Zomig vs. Emgality
See how Zomig and Emgality compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Zomig is taken as needed to stop a migraine once it starts, while Emgality is injected monthly to prevent migraines before they begin.
Zomig comes in tablet, dissolving tablet, and nasal spray forms, while Emgality is only available as a once-monthly injection.
Emgality has no cardiovascular restrictions the way Zomig does, but Zomig can relieve an attack within hours while Emgality takes weeks to build its preventive effect.
Zomig vs. Emgality Drug Summary
Zomig
Zomig (zolmitriptan) is a triptan that treats acute migraine attacks by narrowing blood vessels and blocking pain signals in the brain. It comes as a tablet, an orally disintegrating tablet, or a nasal spray, and is taken as needed when a migraine starts, not on a daily schedule.
Emgality
Emgality (galcanezumab-gnlm) is a monoclonal antibody that blocks calcitonin gene-related peptide (CGRP) to prevent migraines before they occur. It's given as a once-monthly injection under the skin, with a double dose in the first month, and is also approved for episodic cluster headache.
Zomig vs. Emgality Side Effects
Zomig
Emgality
Zomig vs. Emgality Dosage
Zomig
Emgality
| STAGE | DOSE | WHEN |
| Starting dose | 1.25 mg or 2.5 mg | At the start |
| Maximum dose | 5 mg as single dose | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 240 mg | Day 1 |
| Maximum dose | 300 mg once monthly | If needed |
| Dose changes | 2 increases | As tolerated |
Zomig
| STAGE | DOSE | WHEN |
| Starting dose | 1.25 mg or 2.5 mg | At the start |
| Maximum dose | 5 mg as single dose | If needed |
| Dose changes | 2 increases | As tolerated |
Emgality
| STAGE | DOSE | WHEN |
| Starting dose | 240 mg | Day 1 |
| Maximum dose | 300 mg once monthly | If needed |
| Dose changes | 2 increases | As tolerated |
Zomig vs. Emgality Indications
Zomig
Zomig is FDA-approved for the acute treatment of migraine with or without aura in adults. It's meant to stop a migraine that has already started, not to prevent future attacks.
Acute treatment of migraine with or without aura
Taken at the first sign of a migraine attack
Available as tablet, orally disintegrating tablet, or nasal spray
Not approved for migraine prevention or cluster headache
Emgality
Emgality is FDA-approved for the preventive treatment of migraine in adults and for episodic cluster headache. It's meant to reduce how often attacks happen, not to relieve one once it starts.
Preventive treatment of migraine
Treatment of episodic cluster headache
Given as a once-monthly injection
Not approved for acute migraine relief
Zomig vs. Emgality Pros and Cons
Zomig
Zomig acts quickly to relieve pain, nausea, and light sensitivity once a migraine has started, and it comes in three formulations to fit different needs. It isn't a preventive option, and its vasoconstrictive action means it can't be used by people with cardiovascular disease.
Pros
Works within hours to stop an active migraine attack
Three formulations: tablet, ODT, and nasal spray
Nasal spray option when nausea makes pills hard to keep down
Available as a generic, often $13 to $100 a month, far less than Emgality's $650 to $900
Cons
Contraindicated in patients with heart disease or stroke history
Not approved for migraine prevention
Frequent use raises risk of medication overuse headache
May need a second dose if the first doesn't fully work
Emgality
Emgality works in the background to lower how many migraine or cluster headache days a person has, rather than treating attacks as they happen. It avoids the cardiovascular restrictions of triptans, but it takes weeks to reach full effect and does nothing during an active attack.
Pros
Once-monthly injection instead of dosing for each attack
No cardiovascular contraindications, unlike triptans
Also approved for episodic cluster headache
No boxed warning on the label
Cons
Injection site reactions are common
Does not treat an attack once it has started
Takes weeks to build up its preventive effect
Costs roughly $650 to $900 a month, much higher than generic zolmitriptan
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