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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist. It induces vasoconstriction of intracranial blood vessels and inhibits the release of pro-inflammatory neuropeptides. It is available as conventional tablets and orally disintegrating tablets (ODT).
## Primary Indications
Acute treatment of migraine with or without aura in adults and pediatric patients.
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg.
* **Dosing Interval:** If migraine persists or recurs, may repeat dose after 2 hours.
* **Maximum Daily Dose:** 30 mg in a 24-hour period. Do not exceed 3 doses in 24 hours.
## Pediatric Dosing
* **6 to 17 years (weight ≥ 40 kg):** 10 mg as a single dose.
* **6 to 17 years (weight 20 kg to < 40 kg):** 5 mg as a single dose.
* **Note:** Efficacy in treating repeat attacks in pediatric patients has not been established; generally, limit to one dose per 24 hours per safety guidelines.
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific adjustment required, but use with caution.
* **Propranolol Use:** Patients taking propranolol should receive the lower dose (5 mg) because propranolol increases rizatriptan plasma concentrations. The maximum dose is 15 mg per 24 hours.
## Contraindications
* History of ischemic heart disease (MI, angina, silent ischemia).
* History of coronary artery vasospasm (Prinzmetal's angina).
* 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, and sensation of chest/neck tightness or heaviness (usually transient).
Serious: Coronary artery vasospasm, arrhythmias, myocardial infarction, serotonin syndrome (when used with other serotonergic agents).
## Key Drug Interactions
* **MAOIs:** Significantly increase rizatriptan exposure; strictly contraindicated.
* **Propranolol:** Increases rizatriptan AUC by ~70%; dose reduction required.
* **SSRIs/SNRIs:** Potential risk for serotonin syndrome; monitor for symptoms (agitation, tachycardia, hyperreflexia).
* **Ergot-containing drugs:** Increased risk of prolonged vasospastic reactions; avoid within 24 hours of each other.
## Monitoring
* Monitor cardiovascular status in patients with risk factors for coronary artery disease (post-menopausal women, men >40, uncontrolled hypertension).
* Assess for chest pain, palpitations, or signs of serotonin syndrome.
## Clinical Pearls
* ODT formulations should not be removed from the blister pack until the moment of administration; no water is needed, but the tablet must be placed on the tongue and allowed to dissolve.
* Rizatriptan is not indicated for the prevention of migraine or the treatment of hemiplegic or basilar migraine.
* Medication Overuse Headache (MOH) may occur with frequent use (typically ≥10 days per month).
* Clinical practice may vary based on local institutional protocols regarding titration or pediatric frequency limits.
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*Disclaimer: This information is for educational purposes and does not replace professional medical judgment. Always verify current prescribing information, contraindications, and local protocols through official resources like DailyMed or the package insert before prescribing or administering medication.*
