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# 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 is available as standard tablets and orally disintegrating tablets (ODT). ## Primary Indications Acute treatment of migraine headaches in adults and pediatric patients (aged 6 to 17 years). Not indicated for migraine prophylaxis or management of hemiplegic/basilar migraines. ## Adult Dosing * **Initial dose:** 5 mg or 10 mg at onset of migraine. * **Redosing:** If symptoms persist or recur, a second dose may be administered at least 2 hours after the first dose. * **Maximum dose:** 30 mg in a 24-hour period. * **Dosage for patients on propranolol:** Use 5 mg dose; maximum of 15 mg in 24 hours. ## Pediatric Dosing Patients aged 6 to 17 years: * **Weight <40 kg:** 5 mg. * **Weight ≥40 kg:** 10 mg. * **Redosing:** If symptoms persist, a second dose may be administered after 2 hours. * **Maximum dose:** Only one dose is typically recommended in 24 hours; clinical guidelines vary, verify local institutional protocols for repeat dosing in children. ## Dose Adjustments * **Renal impairment:** No dosage adjustment necessary. * **Hepatic impairment:** Use with caution in mild-to-moderate impairment (consider 5 mg dose). Avoid use in severe hepatic impairment. * **Drug-drug interactions:** 5 mg dose limit for patients on propranolol. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or MI. * Uncontrolled hypertension. * History of stroke or transient ischemic attack (TIA). * Peripheral vascular disease. * Severe hepatic impairment. * Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication. * Concurrent use with or within 2 weeks of MAO inhibitors. ## Adverse Effects * **Common:** Paresthesia, somnolence, dizziness, fatigue, and chest tightness/heaviness (non-cardiac). * **Serious:** Myocardial ischemia, coronary artery vasospasm, arrhythmias, hypertensive crisis, and serotonin syndrome (especially with SSRIs/SNRIs). ## Key Drug Interactions * **MAO Inhibitors:** Risk of serotonin syndrome and increased rizatriptan plasma levels. * **Propranolol:** Increases rizatriptan plasma concentrations by ~70%; requires dosage reduction. * **SSRI/SNRI/Triptans:** Potential risk of serotonin syndrome; monitor for neuromuscular or autonomic changes. * **Ergot-containing drugs:** Additive risk of increased blood pressure or coronary vasospasm. ## Monitoring * Monitor blood pressure during initial use. * Monitor for signs of serotonin syndrome (if on concomitant serotonergic agents). * Assess for cardiac symptoms (chest pain, shortness of breath) if risk factors are present. ## Clinical Pearls * **ODT Administration:** The ODT formulation should be placed on the tongue and allowed to dissolve; no liquid is required for administration. The blister pack should be dry when peeling to prevent tablet breakage. * **Efficacy:** Most effective when taken as early as possible after the onset of the migraine headache. * **Cardiac Safety:** For patients with cardiovascular risk factors, perform a cardiovascular evaluation before the first dose; the first dose should be administered in a medical setting if there is significant concern. *** *Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Always consult current institutional guidelines and the manufacturer’s full prescribing information (package insert) before prescribing or administering medication.*