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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It is available as oral tablets and orally disintegrating tablets (ODT).
## Primary Indications
Acute treatment of migraine attacks 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 if migraine persists.
* **Maximum Daily Dose:** 30 mg in a 24-hour period.
## Pediatric Dosing
* **Weight < 40 kg:** 5 mg.
* **Weight ≥ 40 kg:** 10 mg.
* **Repeat Dose:** May repeat after 2 hours if migraine persists.
* **Maximum Daily Dose:** 5 mg (if < 40 kg) or 10 mg (if ≥ 40 kg) in a 24-hour period.
## Dose Adjustments
* **Propranolol:** Reduce rizatriptan dose to 5 mg (max two doses in 24 hours, total 10 mg/24h) due to increased rizatriptan plasma concentrations.
* **Renal/Hepatic Impairment:** No specific adjustment required for mild to moderate impairment; use caution in severe hepatic impairment.
## Contraindications
* History of ischemic heart disease, coronary artery vasospasm (Prinzmetal's angina), or history of 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-type medication.
* Current or recent (within 2 weeks) use of MAO-A inhibitors.
## Adverse Effects
* **Common:** Paresthesia, somnolence, dizziness, fatigue, nausea, and chest pain/pressure/tightness (usually non-cardiac).
* **Serious:** Coronary artery vasospasm, arrhythmias, myocardial infarction, serotonin syndrome, and cerebral hemorrhage.
## Key Drug Interactions
* **MAO-A inhibitors:** Contraindicated.
* **SSRIs/SNRIs:** Increased risk of serotonin syndrome; monitor closely.
* **Propranolol:** Decreases rizatriptan clearance (requires dose reduction).
## Monitoring
* Monitor cardiovascular status in patients with risk factors for coronary artery disease (e.g., postmenopausal women, males >40, diabetics) during initial administration.
* Monitor for symptoms of serotonin syndrome (agitation, tachycardia, hyperreflexia).
* Evaluate for medication overuse headache if used >10 days/month.
## Clinical Pearls
* ODT formulations should be placed on the tongue and allowed to dissolve; water is not required.
* The ODT matrix contains phenylalanine; use caution in patients with phenylketonuria.
* Efficacy is generally higher when the drug is taken as soon as the migraine headache begins.
* "Chest symptoms" are common but usually resolved upon exclusion of cardiac etiology; however, any persistent or severe chest pain requires immediate cardiac evaluation.
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*Disclaimer: This information is for educational purposes and is not a substitute for clinical judgment. Always verify current prescribing information, institutional protocols, and patient-specific factors before prescribing or administering medication.*
