Tab%252525252525252525252525252525252525252525252525252525252525252525252520rizatriptan

# 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 (ODT). ## Primary Indications Acute treatment of migraine with or without aura in adults and pediatric patients. It is not indicated for the prophylactic therapy of migraine or for the treatment of hemiplegic or basilar migraine. ## Adult Dosing * **Initial Dose:** 5 mg or 10 mg. * **Redosing:** If headache returns, a second dose may be taken after at least 2 hours. * **Maximum Dose:** 30 mg in a 24-hour period. * *Note:* Use the 5 mg dose for patients receiving concomitant propranolol. ## Pediatric Dosing Patients 6 to 17 years of age: * **Weight < 40 kg:** 5 mg once. * **Weight ≥ 40 kg:** 10 mg once. * **Redosing:** If headache recurs, a second dose may be taken after at least 2 hours. * **Maximum:** Only one dose in 24 hours is recommended for pediatric patients due to lack of safety data for multiple doses. ## Dose Adjustments * **Propranolol:** Reduce rizatriptan dose to 5 mg (max 15 mg/24 hours) due to increased rizatriptan plasma concentrations. * **Renal/Hepatic Impairment:** No specific dosage adjustment required; however, clinical data are limited in severe impairment. ## Contraindications * History of ischemic heart disease (e.g., angina pectoris, MI, silent ischemia). * Coronary artery vasospasm (Prinzmetal’s angina). * Wolff-Parkinson-White syndrome or arrhythmias associated with other cardiac accessory conduction pathway disorders. * History of stroke or transient ischemic attack (TIA). * Peripheral vascular disease. * Ischemic bowel disease. * Uncontrolled hypertension. * Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication. * Use within 2 weeks of discontinuing a monoamine oxidase-A (MAO-A) inhibitor. ## Adverse Effects * **Common:** Dizziness, somnolence, paresthesia, fatigue, and dry mouth. * **Serious:** Myocardial ischemia/infarction, coronary artery vasospasm, arrhythmia, hypertension, and serotonin syndrome (especially when combined with SSRIs/SNRIs). ## Key Drug Interactions * **MAO-A Inhibitors:** Potentiate rizatriptan; contraindicated. * **Propranolol:** Significant increase in rizatriptan exposure; requires dose reduction. * **SSRIs/SNRIs:** Increased risk of serotonin syndrome; monitor for symptoms (agitation, tachycardia, hyperreflexia). * **Ergot-containing drugs:** Additive vasospastic effects; wait 24 hours between administration. ## Monitoring * Monitor blood pressure periodically after the first dose. * Observe for chest, jaw, or neck pain/tightness, which may suggest cardiac ischemia. * Monitor for symptoms of serotonin syndrome if used with serotonergic agents. ## Clinical Pearls * **ODT Administration:** The ODT formulation should be placed on the tongue and allowed to dissolve. It does not require water, making it convenient for patients with nausea. * **Cardiovascular Caution:** For patients with risk factors for coronary artery disease (postmenopausal women, men >40, smokers, diabetics), assess cardiovascular status before the first dose. * **Efficacy:** Headache relief is often most effective when the medication is taken as soon as the migraine attack begins. *** *Disclaimer: This information is for educational purposes only. Drug dosing, contraindications, and interactions can change. Always verify current prescribing information using official package inserts or a clinical drug database (e.g., Lexicomp, Micromedex) before prescribing or administering medication.*