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# Rizatriptan
## Overview
Rizatriptan is a selective 5-HT1B/1D receptor agonist (triptan) used for the acute treatment of migraine headaches with or without aura. It acts via cranial vessel vasoconstriction and inhibition of pro-inflammatory neuropeptide release.
## Primary Indications
Acute treatment of migraine headaches. Not indicated for prophylaxis or hemiplegic/basilar migraines.
## Adult Dosing
* **Standard Dose:** 5 mg or 10 mg orally at symptom onset.
* **Maximum Dose:** 30 mg in a 24-hour period.
* **Redosing:** If the headache recurs, a second dose may be taken at least 2 hours after the first.
* **Orally Disintegrating Tablets (ODT):** Should be placed on the tongue and allowed to dissolve; no liquid is required.
## Pediatric Dosing
* **Age 6–17 years (weighing <40 kg):** 5 mg orally.
* **Age 6–17 years (weighing ≥40 kg):** 10 mg orally.
* **Limit:** Only one dose per 24-hour period in pediatric patients.
## Dose Adjustments
* **Patients on Propranolol:** Reduce dose to 5 mg (max 15 mg/24 hours). Propranolol increases rizatriptan plasma concentrations.
* **Hepatic/Renal Impairment:** Use with caution; consider 5 mg dose in moderate hepatic or renal impairment.
## 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.
* Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication.
* Concurrent use or within 2 weeks of discontinuing a monoamine oxidase (MAO) inhibitor.
## Adverse Effects
* **Common:** Dizziness, somnolence, paresthesia, fatigue, and dry mouth.
* **Sensations:** Chest tightness, pain, or pressure (usually non-cardiac, but must be clinically evaluated if persistent or severe).
* **Rare/Serious:** Coronary vasospasm, arrhythmias, serotonin syndrome, or seizures.
## Key Drug Interactions
* **MAOIs:** Absolute contraindication due to increased risk of serotonin syndrome and elevated triptan levels.
* **SSRIs/SNRIs:** Potential for serotonin syndrome (use caution/monitor).
* **Propranolol:** Known pharmacokinetic interaction requiring dose reduction.
* **Ergot-derivatives:** Do not use within 24 hours (additive vasospastic effects).
## Monitoring
* Assess for chest pain/pressure or signs of cardiac ischemia after the first dose.
* Monitor blood pressure periodically in patients with long-term intermittent use.
* Monitor for signs of serotonin syndrome if used with serotonergic agents.
## Clinical Pearls
* Efficacy is highest when taken as soon as the migraine headache begins.
* Do not use for tension-type headaches.
* If the first dose provides no relief, avoid re-dosing for that same attack; confirm the diagnosis before subsequent use.
* Medication overuse headache (MOH) can occur with frequent use (usually >10 days/month).
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**Educational Disclaimer:** This information is for educational purposes only. Clinical protocols may vary by institution. Always verify current prescribing information, patient-specific allergies, and contraindications before prescribing or administering medication. Consult the official FDA-approved package insert for complete data.
