Tab%252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520rizatriptan

# Rizatriptan ## Overview Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It induces cranial vessel constriction and inhibits the release of pro-inflammatory neuropeptides. It is available as standard tablets and orally disintegrating tablets (ODT). ## Primary Indications Acute treatment of migraine attacks with or without aura in adults and pediatric patients. ## Adult Dosing * **Initial Dose:** 5 mg or 10 mg at the onset of migraine. * **Max 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. ## Pediatric Dosing * **Age 6–17 years (weight-based):** * **< 40 kg:** 5 mg once; may repeat once after 2 hours if needed. * **≥ 40 kg:** 10 mg once; may repeat once after 2 hours if needed. * **Max Dose:** Do not exceed two doses within 24 hours. ## Dose Adjustments * **Propranolol Users:** Reduce dose by 50% (max 5 mg per dose, max 15 mg/24 hours) due to increased rizatriptan plasma concentrations. * **Hepatic/Renal Impairment:** Generally not recommended for severe hepatic impairment; caution (no specific dose adjustment defined) for mild-to-moderate impairment. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or significant cardiac arrhythmias. * 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. * Use within 2 weeks of discontinuing a monoamine oxidase inhibitor (MAOI). ## Adverse Effects * **Common:** Dizziness, somnolence, paresthesia, fatigue, dry mouth, nausea. * **Serious:** Chest pain/tightness (usually non-cardiac, but must be clinically evaluated), myocardial infarction, serotonin syndrome (when combined with serotonergic drugs), hypertension, ischemic events. ## Key Drug Interactions * **MAOIs:** Increases rizatriptan exposure; strictly contraindicated. * **Propranolol:** Increases rizatriptan concentrations; requires dose reduction. * **Serotonergic Agents (SSRIs/SNRIs):** Increased risk of Serotonin Syndrome. * **Ergot-containing drugs:** Additive vasospastic effects; wait 24 hours between administration. ## Monitoring * Monitor blood pressure periodically after the first dose. * Assess for cardiovascular symptoms (chest pain, shortness of breath) during use. * Observe for signs/symptoms of Serotonin Syndrome if used concurrently with other serotonergic medications. ## Clinical Pearls * **ODT Formulation:** ODT tablets should be placed on the tongue and allowed to dissolve; no liquid is required to swallow. * **Timing:** Administer as soon as the migraine headache begins; there is no evidence it is effective during the aura phase. * **Cardiovascular Safety:** If the patient has cardiovascular risk factors (e.g., postmenopausal women, men >40, diabetics), the first dose should ideally be administered under medical supervision to rule out hidden coronary artery disease. *** **Educational Disclaimer:** This information is for educational purposes only. Clinical practice guidelines vary by institution and region. Always verify current prescribing information, patient-specific contraindications, and local protocols via official resources (e.g., FDA-approved product labeling, Lexicomp, or UpToDate) before prescribing or administering medication.