Tab%25252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520rizatriptan

# Rizatriptan ## Overview Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist used for the acute treatment of migraine headaches with or without aura. It is available as standard tablets and orally disintegrating tablets (ODT). ## Primary Indications Acute treatment of migraine headaches. ## Adult Dosing * **Standard Dose:** 5 mg or 10 mg at the onset of migraine. * **Maximum Dose:** 30 mg in a 24-hour period. * **Repeat Dosing:** If symptoms persist or recur, dose may be repeated after a minimum of 2 hours. Do not exceed 30 mg in 24 hours. ## Pediatric Dosing * **Children 6–17 years (weight-based):** * **Weight < 40 kg:** 5 mg as a single dose. * **Weight ≥ 40 kg:** 10 mg as a single dose. * **Maximum:** Dosing is limited to one dose per 24 hours in pediatric patients. Safety/efficacy of repeat dosing in children has not been established. ## Dose Adjustments * **Propranolol:** 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 in mild-to-moderate impairment. Not recommended in severe impairment. ## 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 or ischemic bowel disease. * Uncontrolled hypertension. * Hemiplegic or basilar migraine. * Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication. * MAO-A inhibitor use or within 2 weeks of MAO-A inhibitor discontinuation. ## Adverse Effects * **Common:** Paresthesia, somnolence, dizziness, fatigue. * **Serious:** Coronary vasospasm/myocardial ischemia, arrhythmias, serotonin syndrome (especially with SSRIs/SNRIs), and hypertensive crisis. ## Key Drug Interactions * **MAO inhibitors:** Potentiate rizatriptan levels; strictly contraindicated. * **Propranolol:** Increases rizatriptan bioavailability via inhibition of metabolism. * **Serotonergic agents (SSRIs, SNRIs, TCAs):** Potential risk of serotonin syndrome; monitor clinical status. ## Monitoring * **Cardiac:** Baseline assessment of cardiovascular risk factors in patients with significant risk profiles. Monitor for signs of ischemia (chest pain, shortness of breath) after first dose. * **Neurologic:** Monitor for excessive use leading to medication-overuse headache. ## Clinical Pearls * **ODT Administration:** The ODT formulation should be placed on the tongue and allowed to dissolve; no water is required. Do not split ODT tablets. * **Consistency:** Efficacy has not been established for the treatment of cluster headaches or chronic daily headaches. * **Education:** Patients should be advised that relief should occur within 2 hours; if no relief occurs, the diagnosis of migraine should be re-evaluated. *** *Disclaimer: This information is for educational purposes only. Clinical guidelines and local protocols vary. Always verify current prescribing information, contraindications, and drug interactions via a reliable primary reference (e.g., Lexicomp, UpToDate, or package insert) before prescribing or administering medication.*