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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin receptor agonist (5-HT1B/1D) used for the acute treatment of migraine. It acts via cranial vessel vasoconstriction and inhibition of pro-inflammatory neuropeptide release. It is available as standard tablets and orally disintegrating tablets (ODT).
## Primary Indications
Acute treatment of migraine with or without aura in adults and pediatric patients.
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg at onset of migraine.
* **Redosing:** If symptoms recur or if symptoms do not resolve, a second dose may be taken after at least 2 hours.
* **Maximum Dose:** 30 mg in a 24-hour period.
## Pediatric Dosing
* **Patients 6 to 17 years old:**
* **Weight < 40 kg:** 5 mg single dose.
* **Weight ≥ 40 kg:** 10 mg single dose.
* **Maximum:** Do not repeat dosing within 24 hours in pediatric patients; safety and efficacy of a second dose have not been established.
## Dose Adjustments
* **Propranolol:** Patients taking concomitant propranolol must use the 5 mg dose of rizatriptan. The maximum dose is 15 mg in 24 hours.
* **Renal/Hepatic Impairment:** No specific adjustment is mandated by the FDA, but use caution in patients with hepatic impairment due to increased plasma concentrations.
## Contraindications
* History of ischemic heart disease (e.g., angina, MI).
* Coronary artery vasospasm (Prinzmetal’s angina).
* 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.
* Administration within 14 days of MAO inhibitor use.
## Adverse Effects
* **Common:** Dizziness, somnolence, paresthesia, fatigue, xerostomia.
* **Serious (Rare):** Coronary artery vasospasm, myocardial infarction, arrhythmias, serotonin syndrome (especially when combined with SSRIs/SNRIs).
## Key Drug Interactions
* **MAO Inhibitors:** Risk of severe serotonin syndrome; contraindicated.
* **Propranolol:** Increases rizatriptan plasma levels.
* **SSRIs/SNRIs:** Potential for serotonin syndrome; monitor for symptoms (agitation, tachycardia, hyperreflexia).
* **Ergot alkaloids:** Increased risk of prolonged vasospastic reactions.
## Monitoring
* Monitor cardiovascular status in patients with risk factors for coronary artery disease upon the first dose.
* Observe for signs/symptoms of serotonin syndrome if used with serotonergic agents.
* Assess frequency of use to prevent medication-overuse headache (limit use to < 10 days per month).
## Clinical Pearls
* **ODT Administration:** The orally disintegrating tablet should be placed on the tongue and allowed to dissolve; liquid is not required. It is not recommended for patients with phenylketonuria (contains phenylalanine).
* **Efficacy:** Does not prevent migraines; it is for acute symptom relief only.
* **Cardiac Warning:** If first-dose chest pain or tightness occurs regardless of severity, seek medical evaluation before continued use.
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*Disclaimer: This information is for educational purposes. Clinical protocols and prescribing guidelines may vary by institution. Always consult the most recent FDA-approved prescribing information or institutional clinical guidelines before making prescribing decisions.*
