Tab%2525252525252525252525252525252525252525252520rizatriptan

# Rizatriptan ## Overview Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist used for the acute treatment of migraine headaches with or without aura. It acts by inducing vasoconstriction of intracranial blood vessels and inhibiting the release of pro-inflammatory neuropeptides. ## Primary Indications Acute treatment of migraine attacks in adults and pediatric patients (6–17 years). It is **not** indicated for prophylactic therapy or for the management of hemiplegic or basilar migraines. ## Adult Dosing * **Standard Dose:** 5 mg or 10 mg orally. * **Administration:** If the migraine returns or there is no response, a second dose may be taken after a minimum of 2 hours. * **Maximum Dose:** 30 mg in a 24-hour period. ## Pediatric Dosing Patients 6 to 17 years old: * **Weight < 40 kg:** 5 mg single dose. * **Weight ≥ 40 kg:** 10 mg single dose. * **Note:** Efficacy and safety of repeat dosing in pediatric patients have not been established; do not exceed one dose in 24 hours unless directed by a specialist. ## Dose Adjustments * **Propranolol:** Patients taking propranolol should receive the 5 mg dose (maximum 15 mg/24 hours) due to increased blood levels of rizatriptan. * **Hepatic/Renal Impairment:** Use with caution; consider the 5 mg dose in 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 history of myocardial infarction. * Uncontrolled hypertension. * History of stroke or transient ischemic attack (TIA). * Peripheral vascular disease. * Ischemic bowel disease. * Concomitant use with ergotamine-containing medications or MAO inhibitors (and within 14 days of MAOI therapy). * Hemiplegic or basilar migraine. ## Adverse Effects * **Common:** Dizziness, somnolence, paresthesia, nausea, fatigue, and chest tightness/heaviness (non-cardiac). * **Serious:** Coronary vasospasm, arrhythmias, myocardial infarction, serotonin syndrome (especially with SSRIs/SNRIs), and hypertensive crisis. ## Key Drug Interactions * **Serotonergic Agents (SSRIs/SNRIs/TCAs):** Risk of serotonin syndrome. Monitor closely. * **Ergot-type medications:** Do not administer within 24 hours of rizatriptan. * **Propranolol:** Increases rizatriptan AUC by ~70%. ## Monitoring * Monitor cardiovascular status in patients with multiple risk factors (e.g., diabetics, post-menopausal women, men >40) upon first dose. * Monitor for signs of serotonin syndrome. * Monitor for medication overuse headache if used >10 days per month. ## Clinical Pearls * The orally disintegrating tablet (ODT) does not require water but must be consumed immediately upon removing from the blister pack. * Rizatriptan is one of the faster-acting triptans due to its pharmacokinetic profile. * Ensure the patient understands that this is for acute treatment only, not prevention. * If a patient fails to respond to one triptan, they may respond to another in the class. *** *Disclaimer: This information is for educational purposes and does not replace professional medical judgment. Always verify current prescribing information, institutional protocols, and patient-specific factors via official drug monographs or resources like Lexicomp or Micromedex before prescribing or administering medication.*