Tab%252525252525252525252525252525252525252525252525252525252525252525252525252520rizatriptan

# Rizatriptan ## Overview Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It is available as oral tablets and orally disintegrating tablets (ODT). ## Primary Indications Acute treatment of migraine attacks with or without aura in adults and pediatric patients. ## Adult Dosing * **Initial Dose:** 5 mg or 10 mg at the onset of migraine. * **Repeat Dose:** If headache returns, dose may be repeated after at least 2 hours. * **Maximum Dose:** 30 mg in a 24-hour period. * **Note:** Use the 5 mg dose for patients receiving propranolol. ## Pediatric Dosing (FDA-approved for ages 6–17 years) * **Weight < 40 kg:** 5 mg single dose. * **Weight ≥ 40 kg:** 10 mg single dose. * **Max frequency:** Do not repeat dose within 24 hours in pediatric patients (safety/efficacy of repeat dosing not established). ## Dose Adjustments * **Propranolol:** Reduce rizatriptan dose to 5 mg (max 15 mg in 24 hours) due to increased rizatriptan plasma concentrations. * **Hepatic/Renal Impairment:** Use with caution. Consider 5 mg dose for mild to moderate impairment. Avoid in severe hepatic/renal insufficiency. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or myocardial infarction. * History of stroke or transient ischemic attack (TIA). * Peripheral vascular disease. * Uncontrolled hypertension. * Concomitant use with MAO inhibitors or use within 2 weeks of discontinuing MAO inhibitors. * Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication. ## Adverse Effects * **Common:** Dizziness, somnolence, paresthesia, fatigue, dry mouth, and nausea. * **Serious:** Coronary artery vasospasm, myocardial infarction, arrhythmias, and serotonin syndrome (especially when combined with SSRIs/SNRIs). ## Key Drug Interactions * **MAO Inhibitors:** Risk of excessive serotonin levels/hypertensive crisis. * **Propranolol:** Significantly increases rizatriptan blood levels. * **SSRIs/SNRIs:** Potential risk for serotonin syndrome; monitor for agitation, tremor, or tachycardia. * **Ergots:** Potential for additive vasospastic effects; wait 24 hours between administration. ## Monitoring * Monitor cardiovascular status if cardiovascular risk factors exist. * Observe for signs/symptoms of serotonin syndrome during initiation or dose changes. * Assess efficacy and headache frequency; if ineffective, re-evaluate diagnosis. ## Clinical Pearls * **ODT Administration:** The ODT formulation does not require water; the blister pack should be dry and peeled open with dry hands. * **Timing:** Administer as soon as possible after migraine onset; efficacy is not established if taken *during* the aura phase before headache starts. * **Overuse:** Medication-overuse headache (rebound headache) can occur if used >10 days per month. * **Safety:** If a patient experiences chest pain or tightness, perform a cardiac workup before further administration. *** *Disclaimer: This information is for educational purposes only. Clinical protocols and prescribing information (package inserts) may be updated frequently. Always verify the most current dosing guidelines and contraindications through local institutional protocols or official drug databases (e.g., Lexicomp, UpToDate) before prescribing or administering medication.*