Tab%2525252525252525252525252525252525252525252525252525252525252525252525252520rizatriptan

# Rizatriptan ## Overview Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist. It acts by causing vasoconstriction of intracranial blood vessels and inhibiting the release of pro-inflammatory neuropeptides. It is available as standard tablets and orally disintegrating tablets (ODT). ## Primary Indications Acute treatment of migraine headaches with or without aura in adults and pediatric patients. ## Adult Dosing * **Initial Dose:** 5 mg or 10 mg at the onset of migraine. * **Maximum Single Dose:** 10 mg. * **Dosing Interval:** Allow at least 2 hours between doses. * **Maximum Daily Dose:** 30 mg per 24 hours. ## Pediatric Dosing (Ages 6 to 17) * **Weight < 40 kg:** 5 mg single dose. * **Weight ≥ 40 kg:** 10 mg single dose. * **Maximum Daily Dose:** Only one dose should be taken in a 24-hour period. Efficacy of a second dose has not been established in pediatric populations. ## Dose Adjustments * **Hepatic Impairment:** Use with caution in mild to moderate impairment. Not recommended for severe impairment. * **Renal Impairment:** No dose adjustment necessary. * **Concurrent Propranolol Use:** Propranolol increases rizatriptan plasma concentrations. The maximum dose is 5 mg; do not exceed 15 mg in 24 hours. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or symptomatic Wolff-Parkinson-White syndrome. * History of stroke or transient ischemic attack (TIA). * Peripheral vascular disease or ischemic bowel disease. * Uncontrolled hypertension. * Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication. * MAO-A inhibitor use within the past 14 days. * Severe hepatic impairment. ## Adverse Effects * **Common:** Paresthesia, dizziness, somnolence, fatigue, and sensations of pressure, pain, or tightness in the chest/neck/throat. * **Serious:** Myocardial ischemia, arrhythmias, serotonin syndrome (when combined with serotonergic drugs), and hypertensive crisis. ## Key Drug Interactions * **MAO-A Inhibitors:** Significant risk of serotonin syndrome; contraindicated. * **SSRIs/SNRIs:** Increased risk of serotonin syndrome. * **Propranolol:** Decreases rizatriptan clearance (limit rizatriptan dose). * **Ergot-containing drugs:** Increased risk of coronary vasospasm; avoid concomitant use. ## Monitoring * Monitor blood pressure periodically. * Assess for cardiovascular symptoms (chest pain, shortness of breath) during the first dose administration. * Monitor for signs of serotonin syndrome (agitation, tachycardia, hyperreflexia). ## Clinical Pearls * **ODT Formulation:** The orally disintegrating tablet (ODT) does not require water; the blister pack should be opened with dry hands and placed on the tongue to dissolve. It does not provide inherently faster absorption than the standard tablet. * **Efficacy:** If there is no response to the first dose, the diagnosis of migraine should be re-evaluated before administering a second dose for the same attack. * **Medication Overuse:** Overuse (>10 days/month) can lead to medication-overuse headaches. *** *Disclaimer: This information is for educational purposes only. Clinical guidelines and prescribing information can change. Always verify specific doses and contraindications through official current drug references (e.g., package inserts, Lexicomp, or UpToDate) before prescribing or administering medication.*