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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist used for the acute treatment of migraine. It works by constricting intracranial blood vessels and inhibiting the release of pro-inflammatory neuropeptides. It is available as a conventional tablet and an orally disintegrating tablet (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 at the onset of migraine.
* **Dosing Interval:** If symptoms recur, dose may be repeated after at least 2 hours.
* **Maximum Dose:** 30 mg in a 24-hour period.
## Pediatric Dosing (Aged 6–17)
* **Weight < 40 kg:** 5 mg single dose.
* **Weight ≥ 40 kg:** 10 mg single dose.
* **Note:** If migraine persists or recurs, contact a provider regarding repeat dosing; consistent safety data for multiple doses in pediatric patients is limited.
## Dose Adjustments
* **Renal/Hepatic Impairment:** Mild to moderate impairment usually requires no dose adjustment.
* **Concomitant Propranolol:** Use 5 mg dose. Propranolol increases rizatriptan plasma concentrations. Max daily dose in patients taking propranolol is 15 mg.
## Contraindications
* History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or history of myocardial infarction.
* Uncontrolled hypertension.
* History of stroke or transient ischemic attack (TIA).
* Peripheral vascular disease.
* Ischemic bowel disease.
* Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication.
* Use within 2 weeks of discontinuing MAO inhibitors.
## Adverse Effects
* **Common:** Paresthesia, dizziness, somnolence, fatigue, and sensations of pressure, pain, or tightness in the chest/neck/throat.
* **Serious:** Coronary vasospasm, arrhythmias, myocardial infarction, serotonin syndrome, and medication overuse headache.
## Key Drug Interactions
* **MAO Inhibitors:** Risk of serotonin syndrome and increased rizatriptan levels.
* **Selective Serotonin Reuptake Inhibitors (SSRIs/SNRIs):** Potential risk of serotonin syndrome; monitor closely.
* **Propranolol:** Increases rizatriptan AUC by approximately 70-80%; requires dose reduction.
## Monitoring
* Monitor cardiovascular status in patients with risk factors for coronary artery disease (especially during the first dose).
* Assess for changes in headache frequency (potential medication overuse headache).
* Monitor for signs of serotonin syndrome if used with other serotonergic agents.
## Clinical Pearls
* **ODT Administration:** The orally disintegrating tablet should be placed on the tongue and allowed to dissolve; no liquid is required. Do not remove from the blister pack until ready to take.
* **Efficacy:** Effectiveness is not diminished by the presence of food, though Tmax may be delayed.
* **Cardiac Safety:** If a patient has significant cardiovascular risk factors, perform a cardiovascular evaluation before the first dose.
* **Patient Counseling:** Advise patients that these medications are for the acute treatment of migraine only; not for migraine prophylaxis or for use in hemiplegic or basilar migraine.
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**Educational Disclaimer:** This information is for educational purposes and does not substitute for professional medical judgment. Always verify current prescribing information, institutional protocols, and patient-specific contraindications via official resources (e.g., package insert, Lexicomp, or UpToDate) before prescribing or administering medication.
