Tab%25252525252525252525252525252525252525252520rizatriptan

# Rizatriptan ## Overview Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It causes vasoconstriction of intracranial blood vessels and inhibits the release of pro-inflammatory neuropeptides. It is available as conventional 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. * **Dosing Interval:** If migraine persists or recurs, a second dose may be taken at least 2 hours after the initial dose. * **Maximum Dose:** 30 mg in a 24-hour period. * **Note:** Use 5 mg for patients taking propranolol or with mild-to-moderate hepatic/renal impairment. ## Pediatric Dosing * **Weight < 40 kg:** 5 mg single dose. * **Weight ≥ 40 kg:** 10 mg single dose. * **Dosing Interval:** Efficacy of a second dose has not been established in pediatric patients; therefore, avoid repeating the dose. * **Maximum Dose:** One dose per 24-hour period. ## Dose Adjustments * **Propranolol Concomitant Use:** Limit dose to 5 mg (maximum 15 mg in 24 hours). * **Hepatic/Renal Impairment:** Reduce initial dose to 5 mg for mild-to-moderate impairment. Avoid use in severe hepatic or renal 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 or ischemic bowel disease. * Uncontrolled hypertension. * Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication. * MAO inhibitor use within the last 14 days. ## Adverse Effects * **Common:** Dizziness, somnolence, paresthesia, fatigue, dry mouth, nausea. * **Serious:** Coronary artery vasospasm, myocardial infarction, arrhythmias, serotonin syndrome (especially when combined with SSRIs/SNRIs), and hypertensive crisis. ## Key Drug Interactions * **Propranolol:** Increases rizatriptan plasma concentrations; requires dose reduction as noted above. * **MAOIs:** Contraindicated; may lead to toxic levels of rizatriptan. * **SSRIs/SNRIs:** Risk of serotonin syndrome; monitor closely for mental status changes, autonomic instability, and neuromuscular abnormalities. * **Ergot-containing drugs/other triptans:** Separate administration by at least 24 hours due to additive vasospastic effects. ## Monitoring * Monitor blood pressure periodically, especially in patients with cardiovascular risk factors. * Assess for signs of serotonin syndrome. * Monitor for overuse headache (medication-overuse headache) if used ≥10 days per month. ## Clinical Pearls * **ODT Formulation:** Does not require water; the patient should place it on the tongue and allow it to dissolve. * **Timing:** Administer as soon as the migraine begins; efficacy is not established if taken during the aura phase. * **Cardiovascular Safety:** If the patient has multiple cardiovascular risk factors, the first dose should ideally be administered in a medical setting to monitor for cardiac ischemia. * **Administration:** Efficacy of the ODT formulation is not significantly different from the regular tablet, though patients often prefer the convenience for nausea. *** *Disclaimer: This information is for educational purposes only. Always consult the latest FDA-approved prescribing information, local hospital protocols, or clinical drug databases (e.g., Lexicomp, UpToDate) before prescribing or administering medication.*