Tab%25252525252525252525252525252525252525252525252525252525252525252525252520rizatriptan

# Rizatriptan ## Overview Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist used for the acute treatment of migraine headaches with or without aura. It is available as a conventional tablet and an orally disintegrating tablet (ODT). ## Primary Indications Acute treatment of migraine headaches. Not indicated for prophylactic therapy or for the treatment of hemiplegic or basilar migraines. ## Adult Dosing * **Initial Dose:** 5 mg or 10 mg. * **Maximum Single Dose:** 10 mg. * **Frequency:** If symptoms return, a second dose may be taken at least 2 hours after the first. * **Maximum Daily Dose:** Do not exceed 30 mg in a 24-hour period. ## Pediatric Dosing * **Ages 6 to 17 years:** * **Weight < 40 kg:** 5 mg. * **Weight ≥ 40 kg:** 10 mg. * **Maximum:** One dose per 24 hours. Safety/efficacy of multiple doses in pediatric patients has not been established. ## Dose Adjustments * **Propranolol Users:** Propranolol increases rizatriptan plasma concentrations. Limit dose to 5 mg (maximum of 15 mg per 24 hours). * **Renal/Hepatic Impairment:** Use with caution; consider a 5 mg dose for patients with moderate hepatic impairment. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or myocardial infarction. * 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. * Use within 14 days of monoamine oxidase inhibitor (MAOI) therapy. ## Adverse Effects * **Common:** Dizziness, somnolence, paresthesia, fatigue, and dry mouth. * **Serious:** Coronary vasospasm, transient myocardial ischemia, arrhythmias, and serotonin syndrome (especially when combined with SSRIs/SNRIs). ## Key Drug Interactions * **Propranolol:** Increases rizatriptan exposure; requires dose reduction. * **MAOIs:** Significant risk of serotonin syndrome; contraindicated. * **SSRIs/SNRIs:** Risk of serotonin syndrome (monitor for symptoms). * **Ergot-containing drugs:** Additive vasospastic effects; wait 24 hours between administration. ## Monitoring * Monitor blood pressure periodically. * Assess for cardiovascular symptoms (chest pain, tightness) during initial dosing. * Monitor for signs of serotonin syndrome in patients on concomitant serotonergic medications. ## Clinical Pearls * **ODT Formulation:** The ODT should be kept in the original blister pack until just before use. Remove with dry hands and place on the tongue; it will dissolve and can be swallowed with saliva (water is not required). * **Efficacy:** Efficacy is greatest when taken at the onset of the migraine headache. * **Medication Overuse Headache (MOH):** Limit use to <10 days per month to prevent rebound headaches. * **Uncertainty:** For patients with cardiovascular risk factors, clinical judgment or a formal cardiac evaluation is recommended before the first dose. Ensure consistent adherence to the maximum 24-hour dose limits, which differ between adults and pediatrics. *** *Disclaimer: This information is for educational purposes only. Always verify current prescribing information, institutional protocols, and patient-specific factors via official drug monographs or clinical decision support tools before prescribing or administering medication.*