Tab%2525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520rizatriptan

# Rizatriptan ## Overview Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist used for the acute treatment of migraine. It is available as standard 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 at onset of migraine. * **Max Single Dose:** 10 mg. * **Redosing:** If headache recurs, a second dose may be taken after at least 2 hours. * **Maximum Daily Dose:** 30 mg in a 24-hour period. ## Pediatric Dosing * **Weight 20 kg to <40 kg:** 5 mg. * **Weight ≥40 kg:** 10 mg. * **Frequency:** Single dose per 24 hours. Data on repeat dosing in pediatrics is limited. ## Dose Adjustments * **Renal Impairment:** No specific adjustment required; use with caution in severe impairment. * **Hepatic Impairment:** Use with caution in mild-to-moderate impairment. * **Interaction with Propranolol:** Max dose is 5 mg (single or repeat) because propranolol doubles rizatriptan plasma concentrations. Total daily maximum should not exceed 15 mg. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal's angina), or MI. * History of stroke or transient ischemic attack (TIA). * Peripheral vascular disease. * Uncontrolled hypertension. * Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication. * Use within 2 weeks of MAO inhibitors. * Hemiplegic or basilar migraine. ## Adverse Effects * **Common:** Paresthesia, dizziness, somnolence, fatigue, and throat/chest tightness or heaviness. * **Serious:** Myocardial ischemia, arrhythmias, serotonin syndrome (if combined with SSRIs/SNRIs), and hypertensive crisis. ## Key Drug Interactions * **Propranolol:** Potentiates rizatriptan; requires dose reduction. * **MAOIs:** Risk of significant hypertension. * **SSRIs/SNRIs:** Potential risk of Serotonin Syndrome; monitor for altered mental status and neuromuscular hyperactivity. * **Ergot alkaloids:** Increased risk of prolonged vasospastic reactions. ## Monitoring * Monitor cardiovascular status in patients with multiple risk factors (e.g., postmenopausal women, men >40, smokers, diabetics, hypercholesterolemia) upon first dose. * Monitor for signs of cardiovascular ischemia or serotonin syndrome. * Assess for medication-overuse headache if used >10 days per month. ## Clinical Pearls * **ODT Administration:** The ODT formulation should be placed on the tongue and allowed to dissolve. No water is required. Do not remove from the foil blister until immediately before administration. * **Efficacy:** Efficacy is greatest when administered as soon as possible after the onset of symptoms. * **Uncertainty:** Dosing in patients with severe renal/hepatic impairment requires clinical judgment and pharmacist-physician consultation as clinical trial data is limited for these populations. *** *Disclaimer: This information is for educational purposes only. Prescribing information, including local protocols and patient-specific factors, should be verified via official resources (e.g., FDA-approved labeling, Lexicomp, or UpToDate) before clinical use.*