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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It induces vasoconstriction of intracranial blood vessels and inhibits the release of pro-inflammatory neuropeptides. 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 (aged 6 to 17 years).
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg.
* **Dosing Frequency:** If migraine persists or recurs, a second dose may be taken after at least 2 hours.
* **Maximum Dose:** 30 mg in a 24-hour period.
* **Note:** Use the lowest effective dose.
## Pediatric Dosing (Aged 6–17)
* **Weight < 40 kg:** 5 mg as a single dose.
* **Weight ≥ 40 kg:** 10 mg as a single dose.
* **Maximum Dose:** One dose per 24-hour period. Clinical efficacy for multiple doses in pediatric patients has not been adequately established.
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific dosage adjustments provided in labeling, but use with caution in patients with hepatic impairment due to potential for increased exposure.
* **Interaction with Propranolol:** Reduce dose to 5 mg (maximum 15 mg/24 hours) if the patient is concurrently taking propranolol, as propranolol increases rizatriptan plasma concentrations.
## 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.
* Ischemic bowel disease.
* Uncontrolled hypertension.
* Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication.
* Concurrent use or within 2 weeks of discontinuing a monoamine oxidase inhibitor (MAOI).
## Adverse Effects
* **Common:** Dizziness, somnolence, paresthesia, fatigue, and dry mouth.
* **Serious:** Chest pain, tightness, or pressure (usually non-cardiac, but must be clinically evaluated), cardiac arrhythmias, serotonin syndrome (especially with SSRIs/SNRIs), and peripheral vascular ischemia.
## Key Drug Interactions
* **MAOIs:** Absolute contraindication due to increased systemic exposure.
* **Propranolol:** Increases rizatriptan AUC by roughly 70%.
* **SSRIs/SNRIs:** Potential risk of serotonin syndrome; monitor for symptoms (agitation, tachycardia, hyperreflexia).
* **Ergot alkaloids:** Increased risk of prolonged vasospastic reactions; avoid concomitant use.
## Monitoring
* Monitor blood pressure periodically, especially in patients with cardiovascular risk factors.
* Observe for signs or symptoms of serotonin syndrome if used with serotonergic agents.
* Assess for chest, jaw, or neck pain indicative of cardiac ischemia upon the first dose.
## Clinical Pearls
* **ODT Formulation:** Rizatriptan ODT contains phenylalanine; caution in patients with phenylketonuria (PKU). Do not split the ODT; it is designed to dissolve on the tongue.
* **Lack of Response:** If a patient does not respond to the first dose, the diagnosis of migraine should be re-evaluated before administering a second dose for the same attack.
* **Medication Overuse Headache:** Frequent use (≥10 days per month) can lead to medication overuse headache; advise patients to limit use.
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**Disclaimer:** This information is for educational purposes only. Clinical dosing, contraindications, and interaction profiles may vary based on updated institutional protocols, local guidelines, and individual patient factors. Always verify current prescribing information via official manufacturer labels or reliable clinical resources (e.g., Lexicomp, UpToDate) before prescribing or administering medication.
