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# Rizatriptan
## Overview
Rizatriptan is a selective 5-HT1B/1D receptor agonist (triptan) used for the acute treatment of migraine headaches with or without aura.
## Primary Indications
Acute treatment of migraine attacks in adults and pediatric patients (6–17 years).
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg.
* **Dosing Interval:** May repeat after 2 hours.
* **Maximum Dose:** 30 mg in a 24-hour period.
## Pediatric Dosing
* **Patients 6 to 17 years (weight < 40 kg):** 5 mg; may repeat once after 2 hours.
* **Patients 6 to 17 years (weight ≥ 40 kg):** 10 mg; may repeat once after 2 hours.
* **Maximum Dose:** 10 mg per 24 hours (for < 40 kg) or 20 mg per 24 hours (for ≥ 40 kg).
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific criteria, but use caution in severe impairment.
* **Propranolol Patients:** Reduce dose to 5 mg (maximum 15 mg/24 hours) due to increased rizatriptan plasma concentrations.
## 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.
* Use within 2 weeks of MAO inhibitors.
## Adverse Effects
* **Common:** Dizziness, somnolence, paresthesia, fatigue, dry mouth, nausea.
* **Serious:** Coronary artery vasospasm, myocardial infarction, arrhythmias, serotonin syndrome (if combined with SSRIs/SNRIs).
## Key Drug Interactions
* **Propranolol:** Increases rizatriptan AUC (requires dose reduction).
* **MAO Inhibitors:** Risk of severe serotonin syndrome; concurrent use is contraindicated.
* **SSRIs/SNRIs:** Increased risk of serotonin syndrome; monitor for symptoms (hyperreflexia, tremor, autonomic instability).
* **Ergot-containing drugs:** Additive vasospastic effects; wait 24 hours between administration.
## Monitoring
* Monitor cardiovascular status in patients with risk factors for coronary artery disease.
* Monitor for signs of serotonin syndrome.
* Assess efficacy and frequency of use to prevent medication-overuse headache.
## Clinical Pearls
* The orally disintegrating tablet (ODT) does not require water but should be placed on the tongue and allowed to dissolve; the blister pack should be dry before opening.
* Rizatriptan is not indicated for the prophylactic treatment of migraine or for the treatment of hemiplegic or basilar migraine.
* If the first dose fails, a second dose for the *same* attack is generally ineffective; clinical practice usually dictates reassessing the diagnosis or trying a different therapeutic class.
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*Disclaimer: This information is for educational purposes and reflects common clinical guidelines. Always consult current institutional protocols and the official FDA-approved prescribing information (package insert) before prescribing or administering medication.*
