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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist (triptan) 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
* **Standard Dose:** 5 mg or 10 mg orally.
* **Maximum Single Dose:** 10 mg.
* **Dosing Interval:** If symptoms recur or there is no response, a second dose may be taken after at least 2 hours.
* **Maximum Daily Dose:** 30 mg in a 24-hour period.
## Pediatric Dosing
* **Weight <40 kg:** 5 mg.
* **Weight ≥40 kg:** 10 mg.
* **Dosing Interval:** Single dose per 24 hours. Data on repeat dosing in pediatrics is limited; follow institutional protocols.
## Dose Adjustments
* **Propranolol Use:** Propranolol increases rizatriptan plasma concentrations. Patients taking propranolol should use the 5 mg dose. The maximum daily dose is 15 mg (three 5 mg doses).
* **Renal/Hepatic Impairment:** Generally not recommended in severe hepatic impairment. Use caution in moderate impairment (consider 5 mg 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.
* Ischemic bowel disease.
* Uncontrolled hypertension.
* Administration within 24 hours of another 5-HT1 agonist or ergotamine-derivative.
* Use within 2 weeks of MAO inhibitors.
## Adverse Effects
* **Common:** Paresthesia, dizziness, somnolence, fatigue, and feeling of heaviness or tightness in the chest/neck.
* **Serious:** Coronary vasospasm, myocardial infarction, arrhythmias, serotonin syndrome (when used with other serotonergic drugs).
## Key Drug Interactions
* **MAO Inhibitors:** Risk of severe toxicity; contraindicated.
* **Propranolol:** Increases rizatriptan exposure; requires dose reduction.
* **SSRIs/SNRIs:** Potential risk of serotonin syndrome; monitor for mental status changes and autonomic instability.
* **Ergot-based drugs:** Additive vasospastic effects; separate administration by at least 24 hours.
## Monitoring
* Monitor cardiovascular status in patients with risk factors during the initial dose.
* Assess for "triptan overuse" if frequency exceeds 10 days per month.
## Clinical Pearls
* **ODT formulation:** The orally disintegrating tablet does not require water; however, it should not be removed from the blister pack until immediately before use.
* **Efficacy:** Not indicated for the prevention of migraine. Administer as soon as possible after the onset of the migraine headache.
* **Triptan Selection:** If a patient fails one triptan, switching to another may be effective.
* **Serotonin Syndrome:** Advise patients to report symptoms of serotonin syndrome (e.g., hallucinations, tachycardia, tremor, diarrhea) immediately.
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*Disclaimer: This information is for educational purposes only. Always verify current prescribing information, institutional protocols, and patient-specific factors via the manufacturer’s package insert or official clinical drug references (e.g., Lexicomp, UpToDate) before prescribing or administering medication.*
