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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It is available as standard tablets and orally disintegrating tablets (ODT).
## 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.
* **Dosing Frequency:** If migraine recurs after initial relief, a second dose may be taken at least 2 hours after the first.
* **Maximum Dose:** 30 mg in a 24-hour period.
## Pediatric Dosing
* **Weight < 40 kg:** 5 mg.
* **Weight ≥ 40 kg:** 10 mg.
* **Dosing Frequency:** Single dose per 24 hours. Safety and efficacy of a second dose in children have not been established.
## Dose Adjustments
* **Propranolol:** Patients receiving propranolol should use a reduced dose of 5 mg. The maximum daily dose is 15 mg (three 5 mg doses) in 24 hours.
* **Hepatic/Renal Impairment:** Use with caution; start at the lowest possible dose.
## Contraindications
* History of ischemic heart disease, coronary artery vasospasm (Prinzmetal's angina), or MI.
* History of stroke or transient ischemic attack (TIA).
* Peripheral vascular disease or ischemic bowel disease.
* Uncontrolled hypertension.
* Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication.
* Concomitant use (or within 2 weeks of stopping) of MAO inhibitors.
## Adverse Effects
* **Common:** Paresthesia, dizziness, somnolence, fatigue, and dry mouth.
* **Serious:** Coronary artery vasospasm, arrhythmias, myocardial infarction, serotonin syndrome, and medication overuse headache.
## Key Drug Interactions
* **MAOIs:** Potential for significantly increased rizatriptan plasma concentrations; strictly contraindicated.
* **SSRIs/SNRIs:** Increased risk of Serotonin Syndrome.
* **Propranolol:** Increases rizatriptan plasma levels (requires dose reduction).
* **Ergot alkaloids:** Increased risk of prolonged vasospastic reactions.
## Monitoring
* Monitor for signs of serotonin syndrome (agitation, tachycardia, hyperreflexia).
* Assess for cardiovascular symptoms (chest pain, pressure, tightness) during initial doses.
* Monitor frequency of use to prevent medication overuse headache.
## Clinical Pearls
* **ODT Formulation:** Should be placed on the tongue and allowed to dissolve; no liquid is required. It is not quicker-acting than standard tablets, just easier for patients with nausea.
* **Timing:** Administer as soon as migraine symptoms begin; efficacy is significantly reduced if taken after the headache has fully established.
* **Chest Symptoms:** Non-cardiac chest "tightness" or "pressure" is common after injection or oral triptans but must be clinically evaluated to rule out ischemic heart disease if persistent or concerning.
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**Disclaimer:** This information is for educational purposes only. Always consult current, evidence-based drug monographs and local institutional protocols before prescribing or administering medication.
