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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist used to terminate acute migraine headaches. It is available as oral tablets and orally disintegrating tablets (ODT).
## Primary Indications
Acute treatment of migraine with or without aura in adults and pediatric patients (6–17 years). Not indicated for migraine prophylaxis or hemiplegic/basilar migraine.
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg at the onset of migraine.
* **Dosing Interval:** If the migraine returns or the initial dose is ineffective, a second dose may be taken after at least 2 hours.
* **Maximum Dose:** 30 mg in a 24-hour period.
## Pediatric Dosing
* **Patients 6 to 17 years (weight < 40 kg):** 5 mg single dose.
* **Patients 6 to 17 years (weight ≥ 40 kg):** 10 mg single dose.
* **Note:** Efficacy and safety for a second dose in pediatric patients have not been established. Consult institutional protocols.
## Dose Adjustments
* **Patients taking Propranolol:** Limit dose to 5 mg (maximum 15 mg in 24 hours) due to increased serum concentrations of rizatriptan.
* **Renal/Hepatic Impairment:** No formal dosage adjustments provided in labeling, but use with caution in severe hepatic impairment.
## Contraindications
* History or signs of ischemic heart disease, coronary vasospasm (Prinzmetal's angina), or peripheral vascular disease.
* History of stroke or transient ischemic attack (TIA).
* Uncontrolled hypertension.
* Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication.
* Concurrent use or use within 2 weeks of MAO inhibitors.
## Adverse Effects
Common: Dizziness, somnolence, asthenia/fatigue, and paresthesia.
Serious: Coronary artery vasospasm (rare), serotonin syndrome, and arrhythmias.
## Key Drug Interactions
* **MAO Inhibitors:** Risk of serotonin syndrome; contraindicated.
* **Propranolol:** Increases rizatriptan exposure; requires dose reduction.
* **SSRIs/SNRIs:** Increased risk of serotonin syndrome when combined with triptans; monitor for clinical symptoms.
## Monitoring
* Monitor for signs of cardiovascular ischemia or vasospasm after the first dose.
* Monitor for signs of serotonin syndrome (agitation, tremor, hyperreflexia, hyperthermia).
* Evaluate patient response/headache frequency to ensure appropriate usage (avoid overuse to prevent medication-overuse headache).
## Clinical Pearls
* ODT formulations should be placed on the tongue and allowed to dissolve; no liquid is required. Do not split ODTs.
* Rizatriptan is highly effective but should not be used as a substitute for prophylaxis in patients with frequent attacks.
* Patients with cardiovascular risk factors should undergo a cardiovascular evaluation before the first dose if they are postmenopausal, men >40, or have other cardiac risk factors.
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**Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Prescribers and clinicians must verify all dosing, contraindications, and drug interactions against the most current FDA-approved labeling (e.g., PI/package insert) and local clinical protocols.
