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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It exhibits faster absorption and higher bioavailability compared to many other triptans due to its rapid oral disintegration.
## Primary Indications
Acute treatment of migraine attacks with or without aura in adults and pediatric patients. It is not intended for the prophylactic therapy of migraine or for the treatment of hemiplegic or basilar migraine.
## Adult Dosing
* **Standard dose:** 5 mg or 10 mg orally.
* **Maximum dose:** 30 mg in a 24-hour period.
* **Interval:** May repeat dose after 2 hours.
## Pediatric Dosing
* **Children 6 to 17 years old:**
* **Weight < 40 kg:** 5 mg dose.
* **Weight ≥ 40 kg:** 10 mg dose.
* **Maximum dose:** Single dose only per 24-hour period.
## Dose Adjustments
* **Patients taking Propranolol:** Reduce dose of rizatriptan to 5 mg (maximum 15 mg/24 hours) due to increased rizatriptan plasma concentrations.
* **Hepatic/Renal Impairment:** Use with caution. No formal adjustment guidelines; consider starting at the lowest effective dose.
## Contraindications
* History of ischemic heart disease (e.g., angina, myocardial infarction).
* Coronary artery vasospasm (Prinzmetal’s angina).
* History of stroke or transient ischemic attack (TIA).
* Peripheral vascular disease.
* Ischemic bowel disease.
* Uncontrolled hypertension.
* Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication.
* Use within 2 weeks of discontinuing a monoamine oxidase inhibitor (MAOI).
## Adverse Effects
* **Common:** Paresthesia, dizziness, somnolence, fatigue, and chest tightness or pressure.
* **Serious:** Coronary artery vasospasm, myocardial infarction, arrhythmias, and serotonin syndrome (especially when combined with SSRIs/SNRIs).
## Key Drug Interactions
* **MAOIs:** Absolute contraindication; significantly increases rizatriptan levels.
* **Propranolol:** Increases rizatriptan bioavailability 2-fold.
* **Serotonergic agents (SSRIs, SNRIs, TCAs):** Risk of serotonin syndrome.
* **Ergot alkaloids:** Increased risk of prolonged vasospastic reactions.
## Monitoring
* Monitor blood pressure periodically after the first dose in patients with cardiovascular risk factors.
* Observe for signs/symptoms of serotonin syndrome (agitation, hallucinations, tachycardia, hyperreflexia).
* Assess for overuse (medication-overuse headache) if used >10 days per month.
## Clinical Pearls
* **Administration:** The orally disintegrating tablet (ODT) should be placed on the tongue and allowed to dissolve; no liquid is required. Do not remove the blister pack until immediately before use.
* **Efficacy:** If there is no response to the first dose, a second dose for the *same* attack is not recommended.
* **Patient Counseling:** Advise patients that "triptan sensations" (tightness in the chest or throat) are usually non-cardiac, but persistent or severe chest pain requires immediate medical evaluation.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice protocols and prescribing information can change. Always verify current FDA-approved labeling and institutional guidelines before prescribing or administering medication.
