Tab%252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520rizatriptan

# Rizatriptan ## Overview Rizatriptan is a selective 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 attacks in adults and pediatric patients (6–17 years). Not indicated for migraine prophylaxis or management of hemiplegic/basilar migraines. ## Adult Dosing * **Initial Dose:** 5 mg or 10 mg. * **Frequency:** If the migraine recurs or there is no satisfactory response, a second dose may be taken at least 2 hours after the first. * **Maximum Dose:** 30 mg in any 24-hour period. * **Administration Note:** The ODT should be placed on the tongue and allowed to dissolve; it can be taken without liquid. ## Pediatric Dosing Dosing is weight-based for patients ages 6–17 years: * **Weight < 40 kg:** 5 mg single dose. * **Weight ≥ 40 kg:** 10 mg single dose. * **Repeat Dosing:** Only one dose should be administered per 24-hour period in pediatric patients. ## Dose Adjustments * **Patients on Propranolol:** Decrease dose to 5 mg (maximum 15 mg/24 hours). * **Renal/Hepatic Impairment:** Use with caution. Consider 5 mg starting dose in mild-to-moderate hepatic impairment. Use is not recommended in severe hepatic impairment. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal's angina), or uncontrolled hypertension. * History of stroke or transient ischemic attack (TIA). * Peripheral vascular disease or ischemic bowel syndrome. * Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication. * Use within 2 weeks of MAO inhibitor therapy. ## Adverse Effects * **Common:** Dizziness, somnolence, paresthesia, fatigue, and dry mouth. * **Serious:** Coronary vasospasm/myocardial ischemia (rare), hypertension, serotonin syndrome (if combined with other serotonergic agents). ## Key Drug Interactions * **MAO Inhibitors:** Risk of increased rizatriptan plasma concentrations; strictly contraindicated. * **Propranolol:** Increases rizatriptan bioavailability by ~70%. * **SSRIs/SNRIs:** Potential risk for serotonin syndrome; monitor closely for symptoms (hyperreflexia, tremor, agitation). ## Monitoring * Monitor cardiovascular status in patients with risk factors for coronary artery disease (CAD) if receiving their first dose. * Monitor for signs of serotonin syndrome. * Assess frequency of use to prevent Medication Overuse Headache (MOH). ## Clinical Pearls * Clinical efficacy is high, but patients should be advised that efficacy in one attack does not guarantee efficacy in another. * Patients should be cautioned against exceeding the maximum daily dose to mitigate the risk of coronary events and medication overuse. * Rizatriptan ODT contains phenylalanine; avoid in patients with phenylketonuria. *** *Disclaimer: This information is for educational purposes. Prescribing practices and local guidelines may vary. Always verify current prescribing information, contraindications, and drug interactions via official resources (e.g., package insert, Lexicomp, or UpToDate) before administering medication.*