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# Rizatriptan
## Overview
Rizatriptan is a second-generation triptan (selective 5-HT1B/1D receptor agonist) used for the acute treatment of migraine. It exhibits faster absorption and a broader evidence base for pediatric efficacy compared to many other triptans.
## Primary Indications
* Acute treatment of migraine with or without aura in adults and pediatric patients (6 years and older).
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg orally.
* **Dosing Interval:** If the migraine recurs after the initial relief, a second dose may be taken after at least 2 hours.
* **Maximum Dose:** 30 mg in a 24-hour period.
* **Note:** Use the 5 mg dose for patients taking propranolol.
## Pediatric Dosing
* **Ages 6–17 years (<40 kg):** 5 mg single dose.
* **Ages 6–17 years (≥40 kg):** 10 mg single dose.
* **Dosing Frequency:** Do not repeat within 24 hours (safety of multiple doses in pediatric populations is less established; consult institutional protocol).
## Dose Adjustments
* **Hepatic Impairment:** Patients with mild to moderate hepatic impairment should use the 5 mg dose. Avoid in severe impairment.
* **Renal Impairment:** No specific dosage adjustment required.
* **Drug Interactions:** Limit to 5 mg if the patient is on concurrent propranolol (propranolol increases rizatriptan plasma concentrations).
## Contraindications
* History of ischemic heart disease (e.g., angina, myocardial infarction).
* History of stroke or transient ischemic attack (TIA).
* Peripheral vascular disease or ischemic bowel disease.
* Uncontrolled hypertension.
* Use within 24 hours of another 5-HT1 agonist or ergotamine-derivative.
* Use within 14 days of a Monoamine Oxidase Inhibitor (MAOI).
## Adverse Effects
* **Common:** Paresthesia, dizziness, somnolence, fatigue, and sensations of pressure, tightness, or pain in the chest/neck/throat.
* **Serious:** Coronary artery vasospasm, myocardial infarction, arrhythmias, and serotonin syndrome (rare).
## Key Drug Interactions
* **Propranolol:** Increases rizatriptan exposure; cap rizatriptan dose at 5 mg.
* **SSRIs/SNRIs:** Potential risk of serotonin syndrome; monitor for symptoms (agitation, tremor, hyperreflexia).
* **Ergot-containing drugs/Triptans:** Potential for prolonged vasospastic reactions; wait 24 hours between administration.
* **MAOIs:** Absolute contraindication due to significantly increased rizatriptan levels.
## Monitoring
* Monitor cardiovascular status in patients with multiple risk factors (e.g., postmenopausal women, men >40, uncontrolled hypertension) upon first dose.
* Observe for signs of Serotonin Syndrome if used with other serotonergic agents.
## Clinical Pearls
* **Administration:** Orally disintegrating tablets (ODT) do not require water; instruct patients to place on tongue and allow to dissolve.
* **Efficacy:** Efficacy is greatest when taken as soon as the migraine headache begins.
* **Chest Symptoms:** Patients frequently report "chest tightness" or "heavy chest"; educate patients that while common and typically non-cardiac, severe/persistent symptoms require emergency evaluation to rule out cardiac ischemia.
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*Disclaimer: This information is for educational purposes and does not substitute for professional medical judgment. Always consult the latest FDA-approved prescribing information, local clinical guidelines, or a clinical pharmacist before prescribing or administering medication.*
