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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 inducing vasoconstriction of intracranial blood vessels and inhibiting the release of proinflammatory neuropeptides.
## Primary Indications
Acute treatment of migraine attacks in adults and pediatric patients (6–17 years). Not indicated for migraine prophylaxis or management of hemiplegic/basilar migraine.
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg tablet or orally disintegrating tablet (ODT).
* **Maximum Dose:** 30 mg in any 24-hour period.
* **Redosing:** If headache recurs, a second dose may be taken at least 2 hours after the initial dose.
## Pediatric Dosing
* **Weight < 40 kg:** 5 mg single dose.
* **Weight ≥ 40 kg:** 10 mg single dose.
* **Note:** Only one dose should be administered within a 24-hour period; efficacy of a repeat dose in pediatric patients has not been adequately established.
## Dose Adjustments
* **Concomitant Propranolol:** Use 5 mg dose. The maximum dose is 15 mg in 24 hours.
* **Renal/Hepatic Impairment:** No specific adjustment required; however, clinical data are limited in severe hepatic impairment.
## 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-type medication.
* Use within 2 weeks of discontinuing a monoamine oxidase inhibitor (MAOI).
## Adverse Effects
* **Common:** Paresthesia, somnolence, dizziness, fatigue, and chest tightness/pressure.
* **Serious:** Coronary artery vasospasm, arrhythmias, myocardial infarction, serotonin syndrome (especially with SSRIs/SNRIs), and medication overuse headache.
## Key Drug Interactions
* **Propranolol:** Increases rizatriptan plasma concentrations.
* **MAOIs:** Significant risk of elevated rizatriptan levels; concurrent use is contraindicated.
* **SSRIs/SNRIs:** Potential for serotonin syndrome (monitor for agitation, tremor, or autonomic instability).
* **Ergotamines:** Additive vasoconstrictive effects; avoid within 24 hours.
## Monitoring
* Monitor cardiovascular status in patients with risk factors for coronary artery disease.
* Assess for serotonin syndrome symptoms if the patient is on serotonergic antidepressants.
* Monitor for signs of medication overuse (rebound) headache if used >10 days per month.
## Clinical Pearls
* **ODT Administration:** The orally disintegrating tablet should be placed on the tongue and allowed to dissolve; no liquid is required. Use immediately upon removing from the blister pack.
* **Efficacy:** Take as soon as symptoms begin; efficacy is not established if taken during the aura phase.
* **Warning:** The potential for chest symptoms (pressure/tightness) is common but usually non-cardiac; however, if symptoms are severe or persistent, evaluate for cardiac ischemia.
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*Disclaimer: This information is for educational purposes only and does not constitute medical advice. Dosing and clinical protocols may vary by institution. Always verify current prescribing information in the manufacturer's official package insert, Lexicomp, or UpToDate before prescribing or administering medication.*
