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# Rizatriptan
## Overview
Rizatriptan is a selective 5-HT1B/1D receptor agonist (triptan) used for the acute treatment of migraine attacks. It acts via cranial vessel vasoconstriction and inhibition of pro-inflammatory neuropeptide release. It is available as oral tablets and orally disintegrating tablets (ODT).
## Primary Indications
Acute treatment of migraine with or without aura in adults and pediatric patients (6–17 years). Not indicated for migraine prophylaxis or management of hemiplegic or basilar migraine.
## Adult Dosing
* **Standard dose:** 5 mg or 10 mg orally at the onset of migraine.
* **Maximum dose:** 30 mg in a 24-hour period.
* **Repeat dosing:** If symptoms persist or recur, a second dose may be taken at least 2 hours after the first dose.
## Pediatric Dosing
* **Patients < 40 kg:** 5 mg once.
* **Patients ≥ 40 kg:** 10 mg once.
* **Repeat dosing:** If needed, a second dose may be taken 2 hours after the first. Only one dose is recommended in some protocols; verify institutional policy.
## Dose Adjustments
* **Propranolol:** Concomitant use increases rizatriptan plasma concentrations. Limit dose to 5 mg (max 15 mg/24 hours).
* **Renal/Hepatic Impairment:** Use with caution in mild-to-moderate impairment. Not recommended in severe impairment.
## Contraindications
* History of ischemic heart disease (MI, angina, silent ischemia).
* History of stroke or transient ischemic attack (TIA).
* Peripheral vascular disease.
* Ischemic bowel disease.
* Uncontrolled hypertension.
* Concurrent administration within 2 weeks of MAO inhibitors or within 24 hours of other triptans or ergotamine-type medications.
* Hemiplegic or basilar migraine.
## Adverse Effects
* **Common:** Paresthesia, somnolence, dizziness, fatigue, nausea, dry mouth.
* **Serious:** Coronary artery vasospasm, arrhythmias, myocardial infarction, serotonin syndrome (especially with concomitant SSRIs/SNRIs), hypertensive crisis, medication overuse headache.
## Key Drug Interactions
* **MAOIs:** Potential for serotonin syndrome and increased rizatriptan levels; contraindicated.
* **Propranolol:** Increases rizatriptan bioavailability; dose-capping required.
* **SSRIs/SNRIs:** Increases risk of serotonin syndrome; monitor closely for signs (agitation, tremor, hyperreflexia).
* **Ergot derivatives:** Risk of additive vasoconstrictor effects; avoid concomitant use within 24 hours.
## Monitoring
* Monitor blood pressure periodically, especially in patients with cardiovascular risk factors.
* Observe for signs/symptoms of serotonin syndrome or cardiac ischemia after the first dose.
* Assess frequency of use to prevent medication overuse headache.
## Clinical Pearls
* **ODT formulation:** Place on the tongue and allow to dissolve; requires no water.
* **Efficacy:** Effectiveness is highest when administered at the onset of initial migraine symptoms.
* **Administration:** If the first dose provides no relief, it is generally recommended to avoid a second dose for that specific attack, though this may vary by clinical practice.
* **Safety warning:** Warn patients to seek immediate medical attention if they experience chest pain, tightness, or shortness of breath.
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**Disclaimer:** This information is for educational purposes only. Drug dosing, contraindications, and interaction profiles can change. Always verify current prescribing information using official clinical databases (e.g., Lexicomp, UpToDate, or the FDA label) before prescribing or administering medication.
