Tab%25252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520rizatriptan

# Rizatriptan ## Overview Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist used for the acute treatment of migraine headaches with or without aura. It acts via cranial vessel vasoconstriction and inhibition of proinflammatory peptide release. ## Primary Indications Acute treatment of migraine attacks in adults and pediatric patients (ages 6–17 years). ## Adult Dosing * **Standard Dose:** 5 mg or 10 mg orally. * **Administration:** If the migraine persists or recurs after 2 hours, a second dose may be taken. * **Maximum Dose:** Do not exceed 30 mg in a 24-hour period. * **Note:** Orally disintegrating tablets (ODT) should be placed on the tongue and allowed to dissolve; no liquid is required. ## Pediatric Dosing * **Ages 6 to 17 years:** * Weight < 40 kg: 5 mg dose. * Weight ≥ 40 kg: 10 mg dose. * **Maximum:** One dose per 24-hour period. Efficacy of a second dose in pediatric patients has not been adequately established; safety data is limited regarding repeat dosing within 24 hours. ## Dose Adjustments * **Propranolol:** Reduce rizatriptan dose to 5 mg (maximum 15 mg in 24 hours) due to increased rizatriptan plasma concentrations. * **Hepatic/Renal Impairment:** Use cautiously; consider 5 mg dose in patients with mild-to-moderate impairment. Avoid in severe hepatic impairment. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal angina), or clinical symptoms of MI. * 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 14 days of monoamine oxidase (MAO) inhibitor therapy. ## Adverse Effects * **Common:** Paresthesia, dizziness, somnolence, fatigue, and dry mouth. * **Rare but Serious:** Myocardial infarction, coronary artery vasospasm, transient myocardial ischemia, arrhythmias, and serotonin syndrome (especially when combined with SSRIs/SNRIs). ## Key Drug Interactions * **MAO Inhibitors:** Risk of toxicity; avoid concurrent use. * **Propranolol:** Increases rizatriptan systemic exposure. * **SSRIs/SNRIs:** Potential for serotonin syndrome (clinical monitoring required). * **Ergot-containing drugs:** Increased risk of vasospastic effects; wait 24 hours between administration. ## Monitoring * Monitor cardiovascular status in patients with risk factors for coronary artery disease (CAD) at the first dose. * Assess for chest pain, tightness, or pressure following administration (potential signs of vasospasm). * Monitor for signs of serotonin syndrome if used with serotonergic agents. ## Clinical Pearls * Rizatriptan is not indicated for the prophylaxis of migraine or for the treatment of hemiplegic or basilar migraine. * Medication Overuse Headache (MOH) may occur with frequent use (generally defined as ≥10 days per month); educate patients to limit use. * The ODT formulation does not provide a faster onset of action than the standard tablet, but serves as a convenient alternative for patients with nausea or lack of fluid access. *** *Disclaimer: This information is for educational purposes only and does not constitute medical advice. Dosing and clinical practices may vary based on local institutional protocols. Always verify current prescribing information, package inserts, and clinical guidelines before prescribing or administering medication.*