Tab%2525252525252525252525252525252525252525252525252525252525252520rizatriptan

# Rizatriptan ## Overview Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist (triptan) used for the acute treatment of migraine headaches. It works 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. It is not intended for prophylactic use or for the management of hemiplegic or basilar migraines. ## Adult Dosing * **Standard dose:** 5 mg or 10 mg orally. * **Administration:** If the migraine returns, a second dose may be taken at least 2 hours after the initial dose. * **Maximum daily dose:** 30 mg in a 24-hour period. * **Note:** Orally disintegrating tablets (ODT) should be placed on the tongue and allowed to dissolve; no liquid is required. ## Pediatric Dosing * **Age 6–17 years:** * **Weight <40 kg:** 5 mg once; may be repeated once after 2 hours if necessary. * **Weight ≥40 kg:** 10 mg once; may be repeated once after 2 hours if necessary. * **Maximum:** Not to exceed 2 doses in 24 hours. ## Dose Adjustments * **Patients on Propranolol:** Propranolol increases rizatriptan plasma concentrations. Limit dose to 5 mg; maximum of 15 mg in 24 hours. * **Hepatic/Renal Impairment:** Use with caution in mild-to-moderate impairment. Avoid in severe hepatic impairment. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal angina), or uncontrolled hypertension. * History of stroke or transient ischemic attack (TIA). * Peripheral vascular disease or ischemic bowel disease. * Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication. * Current or recent (within 2 weeks) use of MAO inhibitors. ## Adverse Effects * **Common:** Dizziness, somnolence, paresthesia, and fatigue. * **Chest sensations:** Tightness, pressure, or heaviness (often non-cardiac, but must be clinically evaluated to rule out ischemia). * **Rare:** Serotonin syndrome (if combined with SSRIs/SNRIs), arrhythmias, or myocardial infarction. ## Key Drug Interactions * **Propranolol:** Increases rizatriptan exposure (dose reduction required). * **MAO Inhibitors:** Risk of severe hypertensive crisis or toxicity. * **SSRIs/SNRIs:** Increased risk of serotonin syndrome. * **Ergot-derivatives:** Increased risk of prolonged vasospastic reactions. ## Monitoring * Monitor blood pressure periodically in patients with cardiovascular risk factors. * Assess for chest pain or signs of serotonin syndrome (agitation, tachycardia, hyperreflexia). * Evaluate efficacy after 2–3 attacks; if ineffective, discontinue and reassess diagnosis. ## Clinical Pearls * Administer as soon as possible after migraine onset. * The ODT formulation does not require water but must be used immediately upon removing from the blister pack. * Patients with cardiovascular risk factors should receive their first dose in a supervised clinical setting to monitor for cardiac symptoms. * Use with caution in patients with phenylketonuria (PKU) as the ODT formulation contains phenylalanine. *** *Disclaimer: This information is for educational purposes only. Clinical practice may vary based on local protocols. Always consult the latest FDA-approved prescribing information or a local formulary for updated dosing guidelines and safety warnings before prescribing or administering medication.*