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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It acts via cranial vessel vasoconstriction and inhibition of pro-inflammatory neuropeptide release.
## 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 orally (tablet or orally disintegrating tablet).
* **Dosing Interval:** If migraine recurs or there is no response, a second dose may be taken at least 2 hours after the first.
* **Maximum Dose:** 30 mg in any 24-hour period.
## Pediatric Dosing
* **Weight < 40 kg:** 5 mg single dose.
* **Weight ≥ 40 kg:** 10 mg single dose.
* **Maximum Dose:** Only one dose should be administered within a 24-hour period for pediatric patients. Repeat dosing beyond a single dose has not been established as safe or effective in this population.
## Dose Adjustments
* **Patients taking Propranolol:** Limit dose to 5 mg (maximum 15 mg/24 hours) due to increased rizatriptan plasma concentrations.
* **Renal/Hepatic Impairment:** No specific dosage adjustment, but use with caution in patients with mild to moderate impairment. Use is contraindicated in severe hepatic impairment.
## Contraindications
* History of ischemic heart disease (angina, MI, silent ischemia).
* Coronary artery vasospasm (Prinzmetal’s angina).
* History of stroke or transient ischemic attack (TIA).
* Peripheral vascular disease or ischemic bowel disease.
* Uncontrolled hypertension.
* Use within 24 hours of another 5-HT1 agonist or ergotamine-derivative.
* Use within 2 weeks of monoamine oxidase (MAO) inhibitors.
* Hemiplegic or basilar migraine.
## Adverse Effects
* **Common:** Paresthesia, dizziness, somnolence, fatigue.
* **Sensory/Vascular:** Chest tightness, pressure or heaviness (generally non-cardiac, but must be clinically assessed).
* **Rare:** Serious cardiac events (arrhythmia, MI), serotonin syndrome.
## Key Drug Interactions
* **MAO-A Inhibitors:** Potentiation of rizatriptan; concurrent use is contraindicated.
* **Propranolol:** Increases rizatriptan AUC and Cmax.
* **Serotonergic Agents (SSRIs, SNRIs):** Risk of serotonin syndrome; monitor closely.
* **Ergots/Other Triptans:** Do not combine due to additive vasoconstrictive risk.
## Monitoring
* Assess for chest/neck/throat pain or tightness after the first dose.
* Monitor blood pressure if baseline is elevated or with chronic use.
* Evaluate for symptoms of serotonin syndrome (agitation, tremor, hyperreflexia).
## Clinical Pearls
* Orally disintegrating tablets (ODTs) do not require water; instruct patient to place on the tongue and allow to dissolve, then swallow with saliva.
* Effectiveness is higher if taken at the earliest onset of migraine symptoms.
* Safety of treating more than 4 headaches in a 30-day period has not been established.
* Exclude underlying cardiovascular disease before initiating therapy in patients with risk factors (e.g., postmenopausal women, males >40, diabetics).
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**Educational Disclaimer:** This information is for educational purposes only. Clinical dosing and protocols may vary by institution and local practice. Always consult the most current official prescribing information (package insert) and individual clinical guidelines before prescribing or administering medication.
