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# 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 conventional tablets and orally disintegrating tablets (ODT).
## Primary Indications
Acute treatment of migraine with or without aura in adults and pediatric patients.
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg.
* **Redosing:** May repeat dose after 2 hours if symptoms return or persist.
* **Maximum Daily Dose:** 30 mg in a 24-hour period.
* **Note:** If using the ODT formulation, the dose must be administered without liquid (allow to dissolve on the tongue).
## Pediatric Dosing
* **Age 6 to 17 years (<40 kg):** 5 mg, may repeat once after 2 hours if necessary. Maximum: 10 mg/24 hours.
* **Age 6 to 17 years (≥40 kg):** 10 mg, may repeat once after 2 hours if necessary. Maximum: 20 mg/24 hours.
## Dose Adjustments
* **Hepatic Impairment:** Not specifically defined; use caution.
* **Renal Impairment:** No dosage adjustment necessary.
* **Concomitant Propranolol:** Use 5 mg dose. Maximum 15 mg in 24 hours (due to increased plasma concentrations of rizatriptan).
## Contraindications
* History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or history of myocardial infarction.
* 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.
* Concomitant use or within 2 weeks of discontinuing MAO inhibitors.
## Adverse Effects
* **Common:** Paresthesia, dizziness, somnolence, fatigue, and sensations of tightness or pressure in the chest/throat.
* **Serious:** Coronary vasospasm, myocardial infarction, arrhythmias, and serotonin syndrome (rare, especially when combined with SSRIs/SNRIs).
## Key Drug Interactions
* **Propranolol:** Increases rizatriptan exposure; requires dose reduction as noted above.
* **MAO Inhibitors:** Risk of severe hyertension; strictly contraindicated.
* **SSRIs/SNRIs:** Potential risk of serotonin syndrome; monitor patients for symptoms (agitation, tremor, hyperreflexia).
* **Ergot alkaloids:** Separate administration by at least 24 hours due to additive vasoconstrictor effects.
## Monitoring
* **Cardiac:** Assess for chest pain or signs of ischemia following the first dose in patients with cardiovascular risk factors.
* **Neurological:** Monitor for signs of serotonin syndrome.
* **Efficacy:** Frequency of migraine episodes and response to therapy.
## Clinical Pearls
* **Early Intervention:** Efficacy is greatest when taken at the onset of migraine symptoms.
* **ODT Formulation:** The ODT formulation contains phenylalanine; contraindicated in patients with phenylketonuria (PKU).
* **Medication Overuse Headache (MOH):** Excessive use (typically >10 days per month) may lead to medication overuse headaches.
* **Device Safety:** ODTs should not be removed from the blister pack until immediately before use.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice protocols may vary by institution. Always verify current prescribing information, dosing guidelines, and patient-specific safety factors using official resources such as the FDA-approved package insert or clinical decision support tools before prescribing or administering medication.
