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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It acts via cranial vessel vasoconstriction and inhibition of neuropeptide release.
## Primary Indications
Acute treatment of migraine attacks with or without aura in adults and pediatric patients (6–17 years). Not indicated for migraine prophylaxis or hemiplegic/basilar migraine.
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg.
* **Dosing Interval:** Allow at least 2 hours between doses.
* **Maximum Dose:** 30 mg in a 24-hour period.
* **Note:** Use the 5 mg dose for patients taking propranolol.
## Pediatric Dosing
Approved for children and adolescents 6–17 years of age.
* **Weight < 40 kg (88 lb):** 5 mg single dose.
* **Weight ≥ 40 kg (88 lb):** 10 mg single dose.
* **Maximum Dose:** One dose per 24 hours. Efficacy of a second dose has not been established in pediatric populations.
## Dose Adjustments
* **Propranolol:** Reduce rizatriptan dose to 5 mg (max 15 mg/24 hours).
* **Hepatic/Renal Impairment:** No specific adjustment required, but caution is advised in severe impairment.
## Contraindications
* History of ischemic heart disease, coronary artery vasospasm (Prinzmetal's angina), or myocardial infarction.
* History of stroke or transient ischemic attack (TIA).
* Peripheral vascular disease or ischemic bowel disease.
* Uncontrolled hypertension.
* Use within 24 hours of another 5-HT1 agonist or ergotamine-derivative medication.
* Use within 14 days of a monoamine oxidase inhibitor (MAOI).
## Adverse Effects
* **Common:** Paresthesia, somnolence, dizziness, fatigue, and chest tightness/heaviness (non-cardiac).
* **Serious:** Serotonin syndrome (especially with SSRIs/SNRIs), coronary artery vasospasm, arrhythmias, and myocardial ischemia.
## Key Drug Interactions
* **Propranolol:** Increases rizatriptan plasma concentrations.
* **SSRIs/SNRIs:** Increased risk of serotonin syndrome.
* **Ergot-type medications:** Prolonged vasospastic reactions; avoid concomitant use.
* **MAOIs:** Significantly increase rizatriptan blood levels; strictly contraindicated.
## Monitoring
* Monitor for signs of serotonin syndrome (agitation, tachycardia, hyperreflexia).
* Assess cardiovascular status in patients with risk factors prior to first administration.
* Monitor for medication overuse headache (rebound) with frequent use (>10 days/month).
## Clinical Pearls
* **Administration:** Orally disintegrating tablets (ODT) do not require water; instruct patients to remove from blister pack with dry hands and place on the tongue.
* **Onset:** Relief is generally noted within 30 minutes.
* **Failure:** If the first dose is ineffective, do not take a second dose for the same attack; evaluate alternative therapies.
* **Cardiovascular Risk:** In patients with unknown cardiovascular risk (e.g., post-menopausal females, men >40, uncontrolled diabetes), consider a cardiac evaluation before administration.
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**Disclaimer:** This information is for educational purposes only. Always verify current prescribing information, laboratory values, and institutional protocols via official drug labels (e.g., DailyMed) or clinical decision support software before prescribing or administering medication.
