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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.
## Primary Indications
Acute treatment of migraine attacks with or without aura in adults and pediatric patients. It is not indicated for migraine prophylaxis or the treatment of cluster headaches.
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg.
* **Redosing:** If the migraine recurs or there is no response, a second dose may be taken after at least 2 hours.
* **Maximum Dose:** 30 mg in a 24-hour period.
## Pediatric Dosing
* **Children 6–17 years (weighing ≥40 kg):** 10 mg as a single dose.
* **Children 6–17 years (weighing <40 kg):** 5 mg as a single dose.
* **Redosing:** If the migraine persists, one additional dose may be taken after 2 hours. Do not exceed the maximum daily dose based on weight (5 mg or 10 mg total in 24 hours).
## Dose Adjustments
* **Propranolol Use:** Patients taking propranolol should use a reduced dose of 5 mg (max 15 mg/24 hours) due to increased rizatriptan plasma concentrations.
* **Renal/Hepatic Impairment:** Use with caution; clinical data in severe impairment are limited. Monitor patients closely.
## Contraindications
* History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or silent ischemia.
* History of stroke or transient ischemic attack (TIA).
* Peripheral vascular disease or ischemic bowel disease.
* Uncontrolled hypertension.
* Hemiplegic or basilar migraine.
* Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication.
* Concurrent use with or within 2 weeks of discontinuing MAO inhibitors.
## Adverse Effects
* **Common:** Paresthesia, dizziness, somnolence, fatigue, and sensations of tightness/pressure/heaviness in the chest or throat.
* **Serious:** Myocardial infarction, coronary artery vasospasm, transient myocardial ischemia, arrhythmias, and serotonin syndrome.
## Key Drug Interactions
* **MAO Inhibitors:** Risk of severe hypertension or serotonin syndrome.
* **SSRIs/SNRIs:** Increased risk of serotonin syndrome when combined with triptans.
* **Propranolol:** Increases rizatriptan AUC and Cmax.
* **Ergot-containing drugs:** Increased risk of additive vasospastic effects.
## Monitoring
* Monitor blood pressure periodically after the first dose in patients with cardiovascular risk factors.
* Assess for signs of serotonin syndrome (agitation, hallucinations, tachycardia, neuromuscular hyperactivity).
* Cardiac evaluation is recommended for patients with multiple risk factors (e.g., smoking, obesity, diabetes) who are candidates for first-time use.
## Clinical Pearls
* **Administration:** Orally disintegrating tablets (ODT) should be taken dry without water; they should not be removed from the blister pack until immediately before use.
* **Efficacy:** Efficacy is greatest when administered as soon as possible after symptom onset.
* **Medication Overuse:** Frequent use (≥10 days/month) can lead to medication-overuse headache (rebound).
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*Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Always verify current prescribing information, institutional protocols, and patient-specific factors before administration.*
