Tab%2525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520rizatriptan

# Rizatriptan ## Overview Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist used in the acute treatment of migraine headaches with or without aura. It has a faster onset compared to older generation triptans. ## Primary Indications Acute treatment of migraine attacks in adults and pediatric patients (6–17 years). Not indicated for migraine prophylaxis or treatment of hemiplegic/basilar migraines. ## Adult Dosing * **Standard:** 5 mg or 10 mg orally. * **Administration:** If the migraine recurs or there is no response, a second dose may be taken after a minimum of 2 hours. * **Maximum:** 30 mg in a 24-hour period. ## Pediatric Dosing (6–17 years) * **Weight < 40 kg:** 5 mg once. * **Weight ≥ 40 kg:** 10 mg once. * **Maximum:** Only one dose per 24-hour period is established for pediatric use. ## Dose Adjustments * **Patients taking Propranolol:** Rizatriptan dose must be limited to 5 mg (max 15 mg/24h) due to increased rizatriptan plasma concentrations. * **Renal/Hepatic Impairment:** No specific manufacturer guidelines, but exercise caution in severe hepatic impairment. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or symptomatic Wolff-Parkinson-White syndrome. * 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 ergot-type medication. * Current or recent (within 2 weeks) use of monoamine oxidase (MAO) inhibitors. ## Adverse Effects * **Common:** Dizziness, somnolence, paresthesia, and asthenia/fatigue. * **Sensations:** Tightness, pain, pressure, or heaviness in the chest, neck, or throat (usually non-cardiac). * **Serious:** Coronary vasospasm, myocardial infarction, arrhythmias, and serotonin syndrome. ## Key Drug Interactions * **Propranolol:** Increases rizatriptan bioavailability/levels. * **SSRIs/SNRIs:** Increased risk of Serotonin Syndrome. * **MAO-A Inhibitors:** Potentiate rizatriptan; contraindicated. * **Ergot derivatives:** Additive risk of coronary vasospasm; contraindicated within 24 hours of each other. ## Monitoring * Monitor blood pressure periodically in patients with cardiovascular risk factors. * Assess for chest pain or signs of serotonin syndrome (agitation, tachycardia, hyperreflexia) after the initial dose. ## Clinical Pearls * **Oral Disintegrating Tablet (ODT):** Should be placed on the tongue and allowed to dissolve. Water is not required. * **Medication Overuse Headache:** Frequent use (≥ 10 days/month) can lead to medication overuse headaches; counseling on limit frequency is critical. * **Efficacy:** Effectiveness is significantly reduced if taken after the peak of the migraine headache; administer as soon as symptoms begin. *** *Disclaimer: This information is for educational purposes and does not supersede local institutional protocols. Verify all doses, contraindications, and drug interactions using current prescribing information (package insert) or clinical decision support tools before prescribing or administering.*