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# Rizatriptan
## Overview
Rizatriptan is a selective 5-HT1B/1D receptor agonist (triptan) that induces vasoconstriction of intracranial blood vessels and inhibits the release of pro-inflammatory neuropeptides. It features relatively faster onset and higher oral bioavailability compared to other triptans.
## Primary Indications
Acute treatment of migraine with or without aura in adults and pediatric patients (aged 6 to 17 years).
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg orally.
* **Redosing:** If headache recurs, a second dose may be taken at least 2 hours after the first.
* **Maximum Dose:** 30 mg in a 24-hour period.
* *Note:* Use the 5 mg dose for patients taking propranolol.
## Pediatric Dosing
* **Children 6 to 17 years (<40 kg):** 5 mg orally.
* **Children 6 to 17 years (≥40 kg):** 10 mg orally.
* **Redosing:** A second dose may be taken after 2 hours if necessary.
* **Maximum Dose:** Only one dose is typically recommended in a 24-hour period for pediatric patients; clinical safety data beyond one dose is limited.
## Dose Adjustments
* **Propranolol Use:** Propranolol increases rizatriptan plasma concentrations. Limit dose to 5 mg (max 15 mg/24 hours).
* **Renal/Hepatic Impairment:** No specific adjustment required; however, clinical data in severe impairment are limited. Use caution.
## Contraindications
* History of ischemic heart disease, coronary artery vasospasm (Prinzmetal's angina), or MI.
* Uncontrolled hypertension.
* History of stroke or transient ischemic attack (TIA).
* Peripheral vascular disease or ischemic bowel disease.
* Administration within 24 hours of another 5-HT1 agonist or ergot-type medication.
* Use within 2 weeks of MAO inhibitor therapy.
## Adverse Effects
* **Common:** Dizziness, somnolence, paresthesia, asthenia/fatigue, and nausea.
* **Serious:** Coronary artery vasospasm, myocardial infarction, arrhythmias, serotonin syndrome (when combined with serotonergic drugs), and hypertensive crisis.
## Key Drug Interactions
* **MAO Inhibitors:** Risk of severe hypertensive crisis or toxicity.
* **Propranolol:** Increases rizatriptan AUC/Cmax; requires dose reduction.
* **Serotonergic Agents (SSRIs, SNRIs, TCAs):** Potential risk of serotonin syndrome; monitor clinical status.
* **Ergotamines:** Risk of additive vasospastic effects; separate dosing by at least 24 hours.
## Monitoring
* Monitor blood pressure periodically during initiation.
* Evaluate for signs of serotonin syndrome if used with other serotonergic medications.
* Assess for cardiovascular symptoms (chest pain, pressure, tightness) after the first dose in patients with cardiovascular risk factors.
## Clinical Pearls
* **Administration:** Orally disintegrating tablets (ODT) do not require water; ensure the blister pack is dry before handling.
* **Efficacy:** Efficacy is greatest when taken as soon as the migraine headache begins.
* **Consistency:** If a patient fails to respond to a trial of one triptan, they may successfully respond to another.
* **Medication Overuse Headache:** Limit use to <10 days per month to prevent medication-overuse headache.
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**Disclaimer:** This information is for educational purposes and does not replace professional medical judgment. Always verify current prescribing information and institutional protocols via official drug databases (e.g., Lexicomp, DailyMed) before prescribing or administering medication.
