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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist used for the acute treatment of migraine. It induces cranial vessel constriction and inhibits pro-inflammatory neuropeptide release.
## Primary Indications
Acute treatment of migraine with or without aura in adults and pediatric patients (6–17 years). Not indicated for migraine prophylaxis or hemiplegic/basilar migraine.
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg orally at onset of migraine.
* **Dosing Interval:** If symptoms recur or if there is no response, a second dose may be taken at least 2 hours after the first dose.
* **Maximum Daily Dose:** 30 mg per 24 hours.
## Pediatric Dosing
* **Age 6–17 years (< 40 kg):** 5 mg single dose.
* **Age 6–17 years (≥ 40 kg):** 10 mg single dose.
* **Note:** If symptoms recur, dose may be repeated after 2 hours. Do not exceed 2 doses per 24 hours.
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific adjustment required, but use with caution in moderate to severe impairment.
* **Patients on Propranolol:** Use 5 mg dose (and limit to max 15 mg/24 hours) as propranolol increases rizatriptan plasma concentrations.
## Contraindications
* History of ischemic heart disease (MI, angina, silent ischemia).
* Coronary artery vasospasm (Prinzmetal’s angina).
* Wolff-Parkinson-White syndrome or arrhythmias associated with accessory conduction pathways.
* History of stroke or transient ischemic attack (TIA).
* Peripheral vascular disease.
* Ischemic bowel disease.
* Uncontrolled hypertension.
* Administration within 24 hours of another 5-HT1 agonist or ergotamine-derivative.
* Use within 2 weeks of MAO inhibitors.
## Adverse Effects
* **Common:** Paresthesia, dizziness, somnolence, fatigue, and pain/pressure sensation in the chest, neck, or throat.
* **Serious:** Coronary artery vasospasm, arrhythmias, myocardial infarction, serotonin syndrome, and medication-overuse headache (with frequent use).
## Key Drug Interactions
* **MAOIs:** Absolute contraindication; significantly increases plasma levels.
* **Propranolol:** Increases rizatriptan AU C; dose limit required.
* **SSRIs/SNRIs:** Potential for serotonin syndrome (use caution/monitor).
* **Ergot-containing drugs:** Additive risk of vasospastic reactions; wait 24 hours between administration.
## Monitoring
* Monitor cardiovascular status, especially in patients with cardiovascular risk factors (consider ECG for first dose in high-risk patients).
* Monitor for symptoms of serotonin syndrome (agitation, tachycardia, hyperreflexia).
* Monitor frequency of use; limit use to <10 days per month to avoid medication-overuse headache.
## Clinical Pearls
* **Administration:** Orally disintegrating tablets (ODT) do not require water; remove from blister pack with dry hands and place on tongue.
* **Efficacy:** Effectiveness is independent of the duration of the migraine attack at the time of ingestion.
* **Warning:** Triptan sensations (chest/throat tightness) are often non-cardiac, but must be evaluated if severe, persistent, or accompanied by ECG changes.
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*Disclaimer: This information is for educational purposes. Clinical guidelines, local protocols, and prescribing information (package inserts) should be verified through institutional resources or official databases (e.g., DailyMed, Lexicomp) prior to clinical application.*
