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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist. It induces cranial vessel vasoconstriction, inhibits trigeminal nerve activity, and prevents pro-inflammatory neuropeptide release. 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
* **Standard Dose:** 5 mg or 10 mg orally at symptom onset.
* **Dosing Interval:** May repeat dose after 2 hours if symptoms remain or return.
* **Maximum Dose:** 30 mg in a 24-hour period.
## Pediatric Dosing
* **Weight < 40 kg:** 5 mg orally once. May repeat after 2 hours if needed (max: 10 mg/24 hours).
* **Weight ≥ 40 kg:** 10 mg orally once. May repeat after 2 hours if needed (max: 20 mg/24 hours).
## Dose Adjustments
* **Patients on Propranolol:** Use 5 mg dose. Maximum 15 mg in 24 hours.
* **Hepatic/Renal Impairment:** No specific adjustment is mandated by labeling, but use caution in severe impairment.
## 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.
* Ischemic bowel disease.
* Uncontrolled hypertension.
* Hemiplegic or basilar migraine.
* 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 dry mouth.
* **Serious:** Coronary vasospasm, myocardial infarction, arrhythmias, serotonin syndrome (when used with serotonergic drugs), and medication-overuse headache.
## Key Drug Interactions
* **MAOIs:** Significant increases in rizatriptan plasma concentrations; contraindicated.
* **Propranolol:** Increases rizatriptan AUC by ~70%; dose reduction required.
* **Serotonergic agents (SSRIs/SNRIs):** Increased risk of Serotonin Syndrome; monitor closely.
* **Ergot-containing drugs:** Additive vasospastic effects; separate by at least 24 hours.
## Monitoring
* Monitor blood pressure periodically after initial use.
* Assess for cardiovascular symptoms (chest pain/pressure) following administration.
* Evaluate frequency of use to prevent medication-overuse headache.
## Clinical Pearls
* **ODT Formulation:** The ODT formulation does not require water; the blister pack should be opened with dry hands.
* **Efficacy:** Effectiveness is not diminished by the presence of food, though onset may be slightly delayed.
* **Administration:** It should only be used to treat established migraines, not for prophylaxis.
* **Dosing Protocol:** Always re-verify doses against local institutional protocols or specific formulary restrictions, as some healthcare systems implement stricter quantity limits per month.
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**Educational Disclaimer:** This information is for educational purposes only. Always consult the official FDA-approved package insert or a current clinical drug reference (e.g., Lexicomp, UpToDate) to verify the most current prescribing information and safety data before making clinical decisions.
