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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It induces vasoconstriction of intracranial blood vessels and inhibits the release of pro-inflammatory neuropeptides. It is available as standard tablets and orally disintegrating tablets (ODTs).
## Primary Indications
Acute treatment of migraine attacks with or without aura in adults and pediatric patients (aged 6 to 17 years). Not indicated for migraine prophylaxis or management of hemiplegic or basilar migraine.
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg.
* **Dosing Interval:** If the migraine returns or there is no response, a second dose may be taken at least 2 hours after the initial dose.
* **Maximum Dose:** 30 mg in a 24-hour period.
## Pediatric Dosing
* **Weight <40 kg:** 5 mg dose.
* **Weight ≥40 kg:** 10 mg dose.
* **Dosing Interval:** Single dose per 24-hour period. Safety data for second doses in pediatrics is limited; consult local institutional pediatric protocols.
## Dose Adjustments
* **Propranolol Users:** Reduce dose to 5 mg (maximum 15 mg/24 hours) due to increased rizatriptan plasma concentrations.
* **Renal/Hepatic Impairment:** No specific dosage adjustments provided in labeling, but use caution 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 or ischemic bowel disease.
* Concurrent use of (or use within 2 weeks of) Monoamine Oxidase Inhibitors (MAOIs).
* Concurrent use of (or use within 24 hours of) other 5-HT1 agonists or ergotamine-type medications.
## Adverse Effects
* **Common:** Dizziness, somnolence, fatigue, asthenia, dry mouth, paresthesia.
* **Serious:** Coronary artery vasospasm, myocardial ischemia, arrhythmias, serotonin syndrome (when combined with serotonergic drugs), hypertension, ischemic bowel.
## Key Drug Interactions
* **MAOIs:** Significant risk of increased rizatriptan levels; strictly contraindicated.
* **Propranolol:** Increases rizatriptan bioavailability; requires dose reduction.
* **Serotonergic Agents (SSRIs/SNRIs/Triptans):** Risk of serotonin syndrome.
* **Ergot-containing drugs:** Increased risk of prolonged vasospastic reactions.
## Monitoring
* Monitor cardiovascular status in patients with risk factors for coronary artery disease (first dose should be administered under medical supervision if risk exists).
* Assess for chest pain, tightness, or pressure following administration.
* Monitor for signs of serotonin syndrome (e.g., hyperreflexia, tremor, autonomic instability).
## Clinical Pearls
* **ODT Administration:** Instruct patients to allow the ODT to dissolve on the tongue; no liquid is required for administration. The blister pack should be dry, and the tongue should be clear of debris.
* **Consistency:** Efficacy may vary by attack; counsel patients that failure of one triptan does not preclude success with another.
* **Medication Overuse Headache (MOH):** Excessive use (≥10 days/month) can lead to rebound headaches.
* **Administration Timing:** Administer as soon as migraine symptoms begin; efficacy is significantly reduced if the drug is taken after the headache has reached full intensity.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical protocols and safety data may change. Always verify current prescribing information, contraindications, and dosing guidelines via the official FDA-approved package insert or reliable clinical resources (e.g., Lexicomp, UpToDate) before prescribing or administering medication.
