Tab%25252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520rizatriptan

# Rizatriptan ## Overview Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It exhibits faster onset compared to sumatriptan and is available as a conventional tablet and an orally disintegrating tablet (ODT). ## Primary Indications Acute treatment of migraine with or without aura in adults and pediatric patients. ## Adult Dosing * **Standard Dose:** 5 mg or 10 mg taken at the onset of migraine. * **Dosing Interval:** If symptoms recur, a second dose may be taken at least 2 hours after the first dose. * **Maximum Daily Dose:** 30 mg in any 24-hour period. ## Pediatric Dosing (Ages 6 to 17) * **Weight < 40 kg:** 5 mg single dose. * **Weight ≥ 40 kg:** 10 mg single dose. * **Dosing Interval:** If needed, a second dose may be taken at least 2 hours after the first dose. * **Maximum Dose:** Do not exceed one dose per 24 hours in children; safety/efficacy of multiple doses in pediatric patients is not established. ## Dose Adjustments * **Patients taking Propranolol:** Reduce dose to 5 mg (maximum 15 mg/24 hours) due to increased rizatriptan plasma concentrations. * **Hepatic/Renal Impairment:** Use with caution; consider 5 mg dose for mild-to-moderate impairment. Avoid in severe hepatic impairment. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal's angina), or myocardial infarction. * Uncontrolled hypertension. * History of stroke or transient ischemic attack (TIA). * Peripheral vascular disease. * Ischemic bowel disease. * Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication. * Concomitant use of or within 2 weeks of discontinuing MAO inhibitors. ## Adverse Effects * **Common:** Paresthesia, dizziness, somnolence, fatigue, and dry mouth. * **Serious:** Coronary vasospasm/myocardial ischemia, arrhythmias, serotonin syndrome (when combined with serotonergic drugs), and hypertensive crisis. ## Key Drug Interactions * **MAOIs:** Absolute contraindication; MAO-A inhibition significantly increases rizatriptan exposure. * **SSRI/SNRIs:** Risk of serotonin syndrome. Monitor for altered mental status and neuromuscular hyperactivity. * **Propranolol:** Increases rizatriptan bioavailability by ~70%. ## Monitoring * Monitor cardiovascular status in patients with multiple risk factors (e.g., postmenopausal women, men >40, uncontrolled HTN, hyperlipidemia, smoking). * Assess for chest pain/pressure or signs of serotonin syndrome. ## Clinical Pearls * **ODT Formulation:** The orally disintegrating tablet should remain in the blister pack until use. It does not require water but should not be split. * **Medication Overuse Headache (MOH):** Excessive use (≥10 days/month) can lead to rebound headaches. * **Efficacy:** If the first dose provides no relief, avoid a second dose for that same attack; verify diagnosis before retreatment. *** *Disclaimer: This information is for educational purposes only. Always consult current clinical practice guidelines, official FDA-approved labeling, or institutional protocols before prescribing or administering medication.*