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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It causes 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 (aged 6 to 17 years).
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg.
* **Repeat Dose:** If the migraine recurs after initial relief, a second dose may be taken. Maintain an interval of at least 2 hours between doses.
* **Maximum Dose:** Do not exceed 30 mg in any 24-hour period.
* **Note:** Use the 5 mg dose for patients taking propranolol or with mild/moderate hepatic/renal impairment.
## Pediatric Dosing
* **Weight < 40 kg:** 5 mg.
* **Weight ≥ 40 kg:** 10 mg.
* **Maximum Frequency:** Limit to one dose per 24 hours. Safety/efficacy of multiple doses in pediatric patients has not been adequately established.
## Dose Adjustments
* **Propranolol:** Reduce rizatriptan dose to 5 mg (propranolol increases rizatriptan plasma concentrations).
* **Hepatic/Renal Impairment:** Use 5 mg in patients with mild to moderate impairment. Avoid in severe impairment (no clinical data).
## Contraindications
* History of ischemic heart disease (e.g., history of MI, angina, silent ischemia).
* Coronary vasospasm (Prinzmetal’s angina).
* Uncontrolled hypertension.
* Hemiplegic or basilar migraine.
* Administration within 24 hours of another 5-HT1 agonist or ergot-type medication.
* Use within 2 weeks of discontinuing a monoamine oxidase inhibitor (MAOI).
## Adverse Effects
* **Common:** Paresthesia, dizziness, somnolence, fatigue, and pain or pressure sensations (chest, neck, or throat).
* **Serious:** Myocardial ischemia/infarction, cardiac arrhythmias, serotonin syndrome (especially when combined with SSRIs/SNRIs), and transient increases in blood pressure.
## Key Drug Interactions
* **MAOIs:** May significantly increase rizatriptan levels; contraindicated.
* **Propranolol:** Increases AUC by 70–80%; requires dose reduction.
* **SSRI/SNRIs:** Potential for serotonin syndrome; monitor patients closely for signs of toxicity (e.g., hyperreflexia, agitation, tremor).
* **Ergotamines:** Additive vasospastic effects; wait 24 hours between administration.
## Monitoring
* Monitor cardiovascular status, especially in patients with cardiovascular risk factors (consider ECG if treating high-risk patients for the first time).
* Monitor for signs of serotonin syndrome.
* Assess for medication overuse headache (MOH) with frequent use (>10 days/month).
## Clinical Pearls
* **ODT Administration:** The ODT formulation does not require water; instruct patients to place it on the tongue and allow it to dissolve, then swallow with saliva.
* **Onset:** Clinical effect is typically observed within 30 minutes.
* **Self-Limiting:** Triptans are not indicated for prophylactic use; they are for acute rescue only.
* **Avoidance:** Avoid use in patients with Wolff-Parkinson-White syndrome associated with arrhythmias.
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*Educational Disclaimer: This information is for educational purposes only and does not constitute medical advice. Always verify current prescribing information, institutional protocols, and patient-specific factors via official drug monographs (e.g., FDA labels, Lexicomp, or UpToDate) before prescribing or administering medication.*
