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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It exhibits faster absorption (particularly the orally disintegrating tablet/ODT) compared to older triptans but shares the same class-wide contraindications involving coronary vasospasm.
## 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 at the onset of migraine.
* **Repeat Dosing:** May repeat dose after 2 hours if symptoms return or persist.
* **Maximum Dose:** 30 mg in a 24-hour period.
## Pediatric Dosing
* **Ages 6 to 17 years (< 40 kg):** 5 mg single dose.
* **Ages 6 to 17 years (≥ 40 kg):** 10 mg single dose.
* **Note:** Efficacy for repeat dosing in pediatric populations has not been adequately established; consult local institutional protocols.
## Dose Adjustments
* **Propranolol Users:** Reduce dose to 5 mg (maximum 15 mg/24 hours) due to increased rizatriptan plasma concentrations.
* **Hepatic/Renal Impairment:** Use with caution; insufficient data to provide specific dose-adjustment guidelines. Consider a lower starting dose in patients with moderate hepatic impairment.
## Contraindications
* History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or myocardial infarction.
* 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-type medication.
* Concurrent administration or within 2 weeks of MAO inhibitor therapy.
## Adverse Effects
* **Common:** Paresthesia, dizziness, somnolence, fatigue, and sensations of tightness/pressure (chest, neck, or throat).
* **Serious:** Coronary vasospasm, arrhythmias, myocardial infarction, serotonin syndrome (when used with other serotonergic agents), and medication-overuse headache.
## Key Drug Interactions
* **MAO Inhibitors:** Risk of severe serotonin toxicity; contraindicated.
* **Propranolol:** Increases rizatriptan bioavailability; dose reduction required.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) / Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** May increase risk of serotonin syndrome; monitor closely.
* **Ergot alkaloids:** Synergistic risk of coronary vasospasm; wait 24 hours between use.
## Monitoring
* Monitor for cardiac symptoms (chest pain/pressure) following the first dose.
* Assess frequency of use to prevent medication-overuse headache.
* Monitor for signs of serotonin syndrome (agitation, tachycardia, hyperreflexia).
## Clinical Pearls
* **ODT Formulation:** The orally disintegrating tablet should not be removed from the blister pack until immediately before use. It dissolves in the mouth and does not require water, providing convenience for patients with migraine-associated nausea.
* **Early Administration:** Efficacy is optimized by taking the medication as soon as headache symptoms begin.
* **Chest Symptoms:** Instruct patients that "tightness" in the chest is a common class effect but requires medical evaluation if it is severe, persistent, or accompanied by ECG changes.
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*Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Always verify current prescribing information, institutional protocols, and patient-specific factors before administering any medication.*
