Tab%252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520rizatriptan

# Rizatriptan ## Overview Rizatriptan is a selective serotonin (5-HT$_{1B/1D}$) receptor agonist used for the acute treatment of migraine. It is available as oral tablets and orally disintegrating tablets (ODT). ## Primary Indications Acute treatment of migraine attacks with or without aura in adults and pediatric patients (aged 6 to 17 years). ## Adult Dosing * **Initial Dose:** 5 mg or 10 mg. * **Administration:** If the migraine returns or the initial response is inadequate, a second dose may be administered at least 2 hours after the first. * **Maximum Dose:** 30 mg in a 24-hour period. ## Pediatric Dosing * **Aged 6 to 17 years (weight < 40 kg):** 5 mg single dose. * **Aged 6 to 17 years (weight ≥ 40 kg):** 10 mg single dose. * **Note:** Efficacy and safety of a second dose in pediatric patients have not been established; local institutional protocols regarding repeat dosing vary. ## Dose Adjustments * **Hepatic Impairment:** Mild to moderate impairment requires no initial adjustment, but caution is advised. Not recommended in severe impairment. * **Renal Impairment:** No dose adjustment necessary. * **Concomitant Propranolol:** Use 5 mg dose. Propranolol increases rizatriptan plasma concentrations; the maximum daily dose is 15 mg (three 5 mg doses) in 24 hours. ## 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 or ischemic bowel disease. * Uncontrolled hypertension. * Administration within 24 hours of another 5-HT$_1$ agonist or ergotamine-type medication. * Use within 2 weeks of discontinuing a monoamine oxidase (MAO) inhibitor. ## Adverse Effects * **Common:** Paresthesia, dizziness, somnolence, fatigue, and pain/tightness in the chest, neck, or throat ("triptan sensations"). * **Severe:** Coronary artery vasospasm, arrhythmias, myocardial infarction, serotonin syndrome, and hypertension. ## Key Drug Interactions * **MAO Inhibitors:** Risk of severe increase in rizatriptan plasma concentrations. * **Propranolol:** Increases rizatriptan levels (requires dose reduction). * **Serotonergic Drugs (SSRIs/SNRIs):** Increased risk of serotonin syndrome. * **Ergot-containing drugs:** Additive risk of vasospastic effects. ## Monitoring * Monitor blood pressure periodically in patients with controlled hypertension. * Assess for cardiovascular symptoms (chest pain, shortness of breath) during the first administration. * Monitor for signs of serotonin syndrome if used with other serotonergic agents. ## Clinical Pearls * **ODT formulation:** ODTs should be placed on the tongue and allowed to dissolve; no liquid is required. Do not use if you have phenylketonuria (contains phenylalanine). * **Timing:** Administer as soon as possible after migraine onset; efficacy is optimal when taken early in the headache phase. * **Overuse:** Limit use to prevent medication-overuse headache (MOH). Frequency should generally not exceed 10 days per month. *** *Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Always verify current prescribing information, institutional guidelines, and patient-specific factors before prescribing or administering medication.*