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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist (triptan) used for the acute treatment of migraine. It acts via cranial vessel vasoconstriction and inhibition of proinflammatory neuropeptide release.
## Primary Indications
Acute treatment of migraine attacks with or without aura in adults and pediatric patients (6 years and older). Not indicated for migraine prophylaxis or hemiplegic/basilar migraine.
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg orally (tablet or orally disintegrating tablet).
* **Redosing:** If migraine returns or initial dose is ineffective, a second dose may be taken at least 2 hours after the first.
* **Maximum Dose:** 30 mg in a 24-hour period.
## Pediatric Dosing
* **Children 6 to 17 years:**
* Weight < 40 kg: 5 mg dose.
* Weight ≥ 40 kg: 10 mg dose.
* **Redosing:** May repeat one dose after 2 hours if necessary.
* **Maximum Dose:** Do not exceed 10 mg (if < 40 kg) or 20 mg (if ≥ 40 kg) in a 24-hour period.
## Dose Adjustments
* **Propranolol:** Patients receiving propranolol must use a reduced 5 mg dose of rizatriptan due to increased plasma concentrations. Maximum 15 mg in 24 hours.
* **Renal/Hepatic Impairment:** Reduce dose to 5 mg for patients with moderate hepatic or severe renal impairment.
## Contraindications
* History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or 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.
* Concurrent use or within 2 weeks of MAO inhibitor therapy.
## Adverse Effects
* **Common:** Paresthesia, dizziness, somnolence, fatigue, and sensations of pressure/tightness or pain in the chest or neck.
* **Serious:** Coronary artery vasospasm, myocardial infarction, arrhythmias, serotonin syndrome (rare), and hypertension.
## Key Drug Interactions
* **MAO Inhibitors:** Risk of massive serotonin accumulation.
* **Propranolol:** Increases rizatriptan exposure.
* **SSRIs/SNRIs:** Potential for serotonin syndrome (clinical significance is debated, but monitor for symptoms).
* **Ergots:** Potential for additive vasospastic effects.
## Monitoring
* Monitor cardiovascular status in patients with multiple risk factors (postmenopausal women, men > 40, diabetics) before initiating therapy.
* Assess for serotonin syndrome if used with other serotonergic agents.
* Evaluate headache frequency and overuse (medication-overuse headache).
## Clinical Pearls
* Orally disintegrating tablets (ODTs) should be placed on the tongue; no water is required. ODTs contain phenylalanine (phenylketonurics warning).
* Efficacy is higher when administered early in the migraine attack.
* Encourage patients to maintain a headache diary to track frequency and medication use.
* Consistent use for >10 days per month may lead to medication-overuse headaches.
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*Disclaimer: This information is for educational purposes only. Drug dosing, contraindications, and interaction profiles may change. Always verify current prescribing information via the manufacturer’s official labeling or institutional clinical resources before prescribing.*
