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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the treatment of migraine headaches with or without aura. It acts by causing vasoconstriction of intracranial blood vessels and inhibiting the release of pro-inflammatory neuropeptides.
## Primary Indications
Acute treatment of migraine attacks in adults and pediatric patients (aged 6–17 years). It is not indicated for the prophylactic therapy of migraines or for cluster headaches.
## Adult Dosing
* **Standard Dose:** 5 mg or 10 mg orally.
* **Administration:** If the migraine recurs after the initial response, a second dose may be administered at least 2 hours after the first dose.
* **Maximum Dose:** Do not exceed 30 mg in a 24-hour period.
## Pediatric Dosing
* **Weight 25 kg to <40 kg:** 5 mg orally.
* **Weight ≥40 kg:** 5 mg or 10 mg orally.
* **Maximum Dose:** Only one dose should be administered within a 24-hour period for pediatric patients. Consultation with a pediatric specialist or local institutional protocol is strongly advised for first-line pediatric administration.
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific criteria, but use with caution in severe hepatic or renal impairment.
* **Concurrent Propranolol Use:** Patients taking propranolol should use the 5 mg dose of rizatriptan (due to increased plasma concentrations); the maximum dose should not exceed 15 mg in 24 hours.
## Contraindications
* History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or MI.
* Uncontrolled hypertension.
* History of stroke or transient ischemic attack (TIA).
* Peripheral vascular disease or ischemic bowel disease.
* Administration within 24 hours of another 5-HT1 agonist or ergotamine-containing medication.
* Use within 2 weeks of discontinuing a monoamine oxidase inhibitor (MAOI).
## Adverse Effects
* **Common:** Paresthesia, dizziness, somnolence, fatigue, nausea, and sensation of heaviness, pressure, or tightness in the throat or chest.
* **Serious:** Myocardial infarction, coronary artery vasospasm, arrhythmias, serotonin syndrome (especially with SSRIs/SNRIs), and hypertensive crisis.
## Key Drug Interactions
* **MAOIs:** May significantly increase rizatriptan plasma levels.
* **Propranolol:** Increases rizatriptan AUC by approximately 70%.
* **SSRIs/SNRIs:** Potential risk of serotonin syndrome; monitor for symptoms (agitation, tachycardia, hyperreflexia).
* **Ergot alkaloids:** Increased risk of prolonged vasospastic reactions.
## Monitoring
* Monitor cardiovascular status in patients with multiple risk factors (e.g., diabetics, postmenopausal women, heavy smokers) upon first dose.
* Assess for "medication overuse headache" if used >10 days per month.
* Monitor for signs/symptoms of serotonin syndrome.
## Clinical Pearls
* **Formulation:** Rizatriptan orally disintegrating tablets (ODT) must be kept in the original blister pack until use. Do not remove and store in other containers as they are moisture-sensitive.
* **Early Intervention:** Efficacy is greatest when taken as soon as a migraine starts, though it can be taken at any phase of the attack.
* **Chest Symptoms:** Patients frequently report chest tightness; clinicians must differentiate between benign vasospastic effects and true cardiac ischemia.
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*Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Always verify current prescribing information, institutional protocols, and patient-specific factors before administering any medication.*
