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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It undergoes oxidative deamination via monoamine oxidase-A (MAO-A).
## 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/basilar migraine.
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg.
* **Dosing Interval:** If migraine recurs after initial relief, a second dose may be taken after at least 2 hours.
* **Maximum Dose:** 30 mg in any 24-hour period.
## Pediatric Dosing (Aged 6–17 Years)
Dosing is weight-based. Use tablets (not orally disintegrating tablets if preferred, though bioequivalence is similar).
* **Weight 20 kg to <40 kg:** 5 mg.
* **Weight ≥40 kg:** 10 mg.
* **Maximum Dose:** A single dose per 24-hour period. Safety and efficacy of a second dose have not been established in pediatric populations.
## Dose Adjustments
* **Propranolol:** Reduce dose to 5 mg (max 15 mg/24h) in patients taking propranolol, as it increases rizatriptan plasma concentrations.
* **Renal/Hepatic Impairment:** No specific adjustment required, but use with caution in patients with hepatic impairment due to reduced metabolic clearance.
## Contraindications
* History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or history of MI.
* 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.
* Concomitant use (or use within 2 weeks) of MAO inhibitors.
## Adverse Effects
Common: Dizziness, somnolence, paresthesia, fatigue, and dry mouth.
Serious: Coronary artery vasospasm, myocardial infarction, arrhythmias, serotonin syndrome (if combined with other serotonergic agents), and hypertension.
## Key Drug Interactions
* **MAO Inhibitors:** Risk of severe serotonin syndrome and increased rizatriptan levels (contraindicated).
* **Propranolol:** Inhibits metabolism; dose reduction required.
* **SSRI/SNRIs:** Increased risk of serotonin syndrome; monitor closely.
* **Ergots:** Potential for additive vasoconstrictor effects; avoid concomitant use within 24 hours.
## Monitoring
* Monitor blood pressure if baseline is elevated.
* Assess for chest/throat tightness or cardiovascular symptoms immediately following administration.
* Monitor for signs/symptoms of serotonin syndrome if used with other serotonergic medications.
## Clinical Pearls
* **Orally Disintegrating Tablets (ODT):** Should be placed on the tongue and allowed to dissolve; no liquid is required. Do not use in patients with Phenylketonuria (contains phenylalanine).
* **Efficacy:** Efficacy is greatest when taken as soon as symptoms begin.
* **Overuse:** Avoid use >10 days per month to prevent medication-overuse headache.
* **Patient Education:** Advise patients that chest symptoms are often non-cardiac (myalgias/spasms) but require medical evaluation if prolonged or severe.
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**Disclaimer:** This information is for educational purposes. Clinical protocols may vary. Always verify current prescribing information, contraindications, and dosing guidelines via official package inserts or hospital-approved clinical decision support tools before prescribing or administering medication.
