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# Rizatriptan ## Overview Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist used for the acute treatment of migraine. It promotes 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 migraines. ## Adult Dosing * **Standard dose:** 5 mg or 10 mg orally. * **Maximum:** 30 mg in a 24-hour period. * **Frequency:** If symptoms return, a second dose may be taken after at least 2 hours. * **Note:** Use the lowest effective dose. Orally disintegrating tablets (ODT) should be used if rapid onset or if swallowing is difficult; take without liquid. ## Pediatric Dosing Approved for children/adolescents (6–17 years) based on weight: * **Less than 40 kg:** 5 mg single dose. * **40 kg or more:** 10 mg single dose. * **Frequency:** If symptoms persist, may repeat once after 2 hours. Do not exceed the maximum single dose. ## Dose Adjustments * **Renal Impairment:** No specific adjustment required. * **Hepatic Impairment:** Use with caution in mild to moderate hepatic impairment; dosing data is limited. * **Concomitant Propranolol:** Use 5 mg dose. Propranolol increases rizatriptan plasma concentrations by approximately 70%. Maximum dose is 15 mg in 24 hours. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal angina), or uncontrolled hypertension. * History of stroke or transient ischemic attack (TIA). * History of peripheral vascular disease or ischemic bowel disease. * Concomitant use within 2 weeks of MAO inhibitors. * Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication. ## Adverse Effects * **Common:** Paresthesia, dizziness, somnolence, fatigue, and dry mouth. * **Serious:** Coronary vasospasm/myocardial ischemia (rare), transient increases in blood pressure, serotonin syndrome (if combined with SSRIs/SNRIs). ## Key Drug Interactions * **MAO Inhibitors:** Risk of toxicity; avoid use within 14 days. * **Propranolol:** Increases rizatriptan exposure (dose limit 5 mg). * **SSRIs/SNRIs:** Potential risk of serotonin syndrome; monitor clinical status. * **Ergot-containing drugs:** Additive vasospastic effects; wait 24 hours between dosing. ## Monitoring * Monitor cardiovascular status in patients with multiple risk factors (e.g., smoking, obesity, diabetes, postmenopausal females, males >40). * Assess for chest/throat tightness or pressure post-dose. * Monitor for signs of serotonin syndrome if used with serotonergic agents. ## Clinical Pearls * **Timing:** Administer as soon as possible after onset of migraine headache. * **ODT Formulation:** The ODT formulation contains phenylalanine (caution in patients with phenylketonuria). * **Medication Overuse Headache:** Frequent use (≥10 days per month) may lead to medication overuse headache; advise patients to limit use. * **Efficacy:** If the patient does not respond to a first dose, the diagnosis should be re-evaluated before attempting a second dose for the same attack. *** *Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Always verify current prescribing information, institutional protocols, and specific patient contraindications through authoritative drug databases (e.g., Lexicomp, Micromedex) or the manufacturer's package insert before prescribing or administering medication.*