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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It exhibits higher oral bioavailability than many other triptans and is available as an oral tablet or orally disintegrating tablet (ODT).
## Primary Indications
Acute treatment of migraine, with or without aura, in adults and pediatric patients (aged 6 to 17 years).
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg.
* **Dosing Interval:** If symptoms recur, dose may be repeated after a minimum of 2 hours.
* **Maximum Dose:** 30 mg in a 24-hour period.
* **Formulation Note:** For ODT, the blister pack must be dry; place on the tongue to dissolve. No water is needed.
## Pediatric Dosing
* **Patients 6 to 17 years (< 40 kg):** 5 mg single dose.
* **Patients 6 to 17 years (≥ 40 kg):** 10 mg single dose.
* **Note:** Efficacy for repeat dosing in patients <18 years has not been established; generally recommended as a single-dose per 24-hour period.
## Dose Adjustments
* **Propranolol Users:** Patients taking propranolol require a reduced dose. Use 5 mg and limit to a maximum of 15 mg in 24 hours.
* **Renal/Hepatic Impairment:** Use caution; clinical data in severe impairment are limited. Consider 5 mg starting dose.
## Contraindications
* History of ischemic heart disease, coronary artery vasospasm (Prinzmetal's angina), or MI.
* History of stroke or transient ischemic attack (TIA).
* Peripheral vascular disease.
* Uncontrolled hypertension.
* Hemiplegic or basilar migraine.
* Concomitant use of MAO inhibitors (or within 2 weeks of discontinuation).
* Use within 24 hours of another 5-HT1 agonist or ergot-type medication.
## Adverse Effects
* **Common:** Paresthesia, dizziness, somnolence, fatigue, and throat tightness.
* **Serious:** Coronary artery vasospasm, myocardial infarction, arrhythmias, and serotonin syndrome (especially when combined with SSRIs/SNRIs).
## Key Drug Interactions
* **Propranolol:** Increases rizatriptan plasma concentrations significantly.
* **MAO-A Inhibitors:** Potentiate rizatriptan levels; contraindicated.
* **SSRIs/SNRIs:** Potential risk of serotonin syndrome; monitor for symptoms (agitation, tachycardia, rigidity).
* **Ergotamines:** Additive vasoconstrictive effects; avoid within 24 hours.
## Monitoring
* Monitor cardiovascular status in patients with multiple risk factors (e.g., postmenopausal women, men >40, uncontrolled hypertension).
* Screen for symptoms of serotonin syndrome.
* Observe for signs of medication-overuse headache if used >10 days per month.
## Clinical Pearls
* Administer as early as possible after onset of migraine.
* Efficacy is not established for the prevention of migraine.
* There is no evidence that a second dose provides additional benefit if the first dose fails to provide relief.
* Patients should be counseled that if they do not experience relief after the first dose, they should contact their provider rather than increasing the dose.
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*Disclaimer: This information is for educational purposes and is not a substitute for professional medical judgment. Always consult the most current prescribing information or your institution’s clinical guidelines before administering medication.*
