Tab%252525252525252525252525252525252525252520rizatriptan

# Rizatriptan ## Overview Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist 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 * **Initial Dose:** 5 mg or 10 mg. * **Repeat Dose:** May repeat after 2 hours. * **Maximum Dose:** 30 mg in a 24-hour period. ## Pediatric Dosing * **Ages 6 to 17 years:** * Weight < 40 kg: 5 mg. * Weight ≥ 40 kg: 10 mg. * **Repeat Dose:** May repeat once after 2 hours if migraine persists. * **Maximum Dose:** Do not exceed one dose in 24 hours for children; safety of >1 dose not established. ## Dose Adjustments * **Propranolol:** Reduce rizatriptan dose to 5 mg (maximum 15 mg in 24 hours). * **Renal/Hepatic Impairment:** Use with caution; consider 5 mg dose for patients with mild to moderate impairment. Not recommended in severe hepatic impairment. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or MI. * Uncontrolled hypertension. * History of stroke or TIA. * Peripheral vascular disease or ischemic bowel disease. * Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication. * Use within 2 weeks of MAO inhibitor therapy. ## Adverse Effects * **Common:** Dizziness, somnolence, paresthesia, fatigue, pain/pressure in the chest or throat (usually transient). * **Serious:** Myocardial ischemia/infarction, cardiac arrhythmias, serotonin syndrome (if combined with serotonergic agents). ## Key Drug Interactions * **MAOIs:** Risk of profound serotonin toxicity; avoid concomitant use. * **Propranolol:** Increases rizatriptan plasma concentrations significantly. * **Serotonergic agents (SSRIs/SNRIs):** Monitor for serotonin syndrome. * **Ergot derivatives:** Separance of at least 24 hours is required to avoid additive vasospastic effects. ## Monitoring * Monitor cardiovascular status in patients with risk factors for CAD (prior to first dose). * Assess for signs of serotonin syndrome (agitation, tremor, hyperreflexia). * Evaluate frequency of use to prevent medication-overuse headache. ## Clinical Pearls * **ODT Administration:** The ODT formulation should be placed on the tongue and allowed to dissolve; no water is required. It should not be removed from the blister pack until immediately before use. * **Timing:** Administer as soon as possible after migraine onset; efficacy is independent of symptom duration but works best when taken early. * **Patient Education:** Advise patients that "chest pressure" is a common side effect but warrants immediate evaluation if severe or persistent. * **Contraindicated in Hemiplegic or Basilar Migraine:** Risk of stroke and cerebral infarction. *** **Educational Disclaimer:** This information is for educational purposes only. Clinical practice protocols vary by institution. Always consult the latest FDA-approved labeling or institutional prescribing guidelines before administration.