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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist used for the acute treatment of migraine. It undergoes oxidative deamination by monoamine oxidase-A (MAO-A).
## Primary Indications
Acute treatment of migraine with or without aura in adults and pediatric patients (aged 6–17 years).
## Adult Dosing
Standard dose is 5 mg or 10 mg orally.
* **Maximum:** 30 mg in a 24-hour period.
* **Redosing:** Wait at least 2 hours between doses.
## Pediatric Dosing
* **6–17 years (weight < 40 kg):** 5 mg single dose.
* **6–17 years (weight ≥ 40 kg):** 10 mg single dose.
* **Maximum:** Do not exceed one dose per 24-hour period in pediatric patients.
## Dose Adjustments
* **Patients taking Propranolol:** Use 5 mg dose. Maximum 15 mg in 24 hours. (Propranolol increases rizatriptan plasma concentrations).
* **Renal/Hepatic Impairment:** No specific adjustment necessary for mild-to-moderate impairment, but exercise caution. Use is not recommended in severe hepatic impairment.
## Contraindications
* History of ischemic heart disease, coronary artery vasospasm (Prinzmetal's angina), or symptomatic Wolff-Parkinson-White syndrome.
* History of stroke or transient ischemic attack (TIA).
* Peripheral vascular disease.
* Uncontrolled hypertension.
* Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication.
* MAO-A inhibitor use within the past 2 weeks.
## Adverse Effects
* **Common:** Dizziness, somnolence, paresthesia, fatigue, nausea, and dry mouth.
* **Serious:** Coronary vasospasm/myocardial ischemia (rare), serotonin syndrome (if used with SSRIs/SNRIs), and hypertensive crisis.
## Key Drug Interactions
* **MAO-A Inhibitors:** Contraindicated; risk of serotonin syndrome and elevated rizatriptan levels.
* **Propranolol:** Increases rizatriptan AUC by ~70%.
* **SSRIs/SNRIs:** Potential for serotonin syndrome (clinical monitoring required).
* **Ergot-containing drugs:** Additive risk of vasospastic effects; separate dosing by at least 24 hours.
## Monitoring
* Monitor blood pressure periodically, especially in patients with cardiovascular risk factors.
* Assess for chest pain, signs of serotonin syndrome (agitation, tachycardia, hyperreflexia), or worsening headache patterns.
## Clinical Pearls
* **Administration:** Orally disintegrating tablets (ODT) do not require water; the blister pack should be opened with dry hands.
* **Efficacy:** Effectiveness is best if administered as soon as possible after migraine onset.
* **Class limitation:** Not indicated for the prophylaxis of migraine or for the treatment of hemiplegic or basilar migraine.
* **Medication Overuse Headache (MOH):** Limit use to ≤ 10 days per month to avoid medication-overuse headaches.
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*Educational Disclaimer: This information is for educational purposes only. Always verify drug doses, contraindications, and patient-specific factors against current institutional protocols, official prescribing information (FDA labels), and clinical decision support tools before prescribing or administering medication.*
