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# Rizatriptan
## Overview
Rizatriptan is a selective 5-HT1B/1D receptor agonist used for the acute treatment of migraine headaches with or without aura.
## Primary Indications
Acute treatment of migraine attacks in adults and pediatric patients (aged 6 to 17 years). Not indicated for migraine prophylaxis or hemiplegic/basilar migraines.
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg at onset of migraine.
* **Maximum Dose:** 30 mg per 24-hour period.
* **Repeat Dosing:** If symptoms persist or recur, dose may be repeated after a minimum of 2 hours.
## Pediatric Dosing (Ages 6–17)
* **Patients < 40 kg:** 5 mg.
* **Patients ≥ 40 kg:** 10 mg.
* **Maximum:** Single dose only per 24-hour period. Safety data for repeat dosing in pediatric patients is limited. Consult local institutional protocols regarding pediatric repeat dosing.
## Dose Adjustments
* **Renal/Hepatic Impairment:** Generally not required, though use 5 mg dose in patients with moderate hepatic impairment.
* **Concomitant Propranolol:** Use 5 mg dose (maximum 15 mg/24 hours). Propranolol increases rizatriptan plasma concentrations.
## Contraindications
* History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s), or uncontrolled hypertension.
* History of stroke or transient ischemic attack (TIA).
* Peripheral vascular disease or ischemic bowel disease.
* Concurrent use (or use within 14 days) of MAO inhibitors.
* Concurrent use (within 24 hours) of other 5-HT1 agonists or ergotamine-type medications.
## Adverse Effects
* **Common:** Paresthesia, dizziness, somnolence, fatigue, and sensations of pressure/tightness in the chest or throat.
* **Serious:** Coronary vasospasm, myocardial infarction, arrhythmias, serotonin syndrome (if combined with serotonergic drugs).
## Key Drug Interactions
* **MAO Inhibitors:** Risk of severe serotonin toxicity.
* **Propranolol:** Increased bioavailability of rizatriptan.
* **SSRIs/SNRIs:** Theoretical risk of serotonin syndrome; monitor for symptoms (confusion, tachycardia, tremor).
* **Ergotamines:** Increased risk of prolonged vasospasm.
## Monitoring
* Monitor blood pressure periodically.
* Assess for cardiovascular symptoms (chest pain, shortness of breath) following first dose.
* Observe for signs/symptoms of serotonin syndrome if combined with other antidepressant therapies.
## Clinical Pearls
* **Administration:** Orally disintegrating tablets (ODT) do not require water; the blister pack should be dry when handled.
* **Efficacy:** Efficacy is greatest when administered as soon as possible after migraine onset.
* **Medication Overuse Headache:** Frequent use (≥ 10 days per month) may lead to medication overuse headache; advise patients to track frequency.
* **Uncertainty Note:** Ensure patient is not experiencing an initial migraine presentation with atypical features, as triptans can be dangerous in undiagnosed cardiovascular/neurological conditions.
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**Disclaimer:** This information is for educational purposes only. Always verify dosing, contraindications, and drug interactions against current institutional protocols and the official FDA-approved prescribing information (package insert) before clinical application.
