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# Rizatriptan ## Overview Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used as an abortive therapy for acute migraine. 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 at onset of migraine. * **Redosing:** If headache recurs after initial relief, a second dose may be taken at least 2 hours after the first. * **Maximum Dose:** 30 mg in a 24-hour period. ## Pediatric Dosing * **Weight < 40 kg:** 5 mg dose. * **Weight ≥ 40 kg:** 10 mg dose. * **Redosing:** A second dose may be taken at least 2 hours after the first. * **Maximum Dose (6–17 years):** Total dose should not exceed 10 mg in a 24-hour period. ## Dose Adjustments * **Patients on Propranolol:** Use 5 mg dose. Maximum 15 mg in 24 hours. * **Hepatic Impairment:** Use 5 mg dose in patients with mild to moderate impairment; avoid in severe impairment. * **Renal Impairment:** No specific adjustment required; use caution in severe impairment. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal's angina), or MI. * Wolff-Parkinson-White syndrome or arrhythmias associated with accessory conduction pathways. * 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. * Use within 2 weeks of MAO inhibitor therapy. ## Adverse Effects * **Common:** Dizziness, somnolence, paresthesia, warm/cold sensations, fatigue, and throat tightness. * **Serious:** Coronary artery vasospasm, myocardial infarction, arrhythmias, serotonin syndrome (if combined with SSRIs/SNRIs), and hypertensive crisis. ## Key Drug Interactions * **MAO Inhibitors:** Risk of significantly increased plasma concentrations; contraindicated. * **Propranolol:** Increases rizatriptan plasma concentrations; dose capped at 15 mg/24h. * **SSRIs/SNRIs:** Potential risk of serotonin syndrome; monitor clinical status. * **Ergot-containing drugs:** Additive vasospastic effects; separate use by at least 24 hours. ## Monitoring * Monitor blood pressure periodically, especially in patients with cardiovascular risk factors. * Observe for signs/symptoms of serotonin syndrome (agitation, tachycardia, hyperreflexia). * Assess for chest pain or tightness following initial administration. ## Clinical Pearls * **ODT Administration:** The ODT formulation should be placed on the tongue and allowed to dissolve; no water is required, which is beneficial for patients experiencing migraine-associated nausea. * **Inconsistency:** Efficacy can vary between attacks; if the first dose fails to provide relief, do not take a second dose for the same attack. * **Medication Overuse:** Frequent use (≥10 days per month) may lead to medication-overuse headache. * **Cardiovascular Screening:** Perform a cardiovascular assessment in patients with multiple risk factors (e.g., smoking, diabetes, obesity, post-menopausal status) before using triptans. *** **Educational Disclaimer:** This information is for educational purposes only. Always verify current prescribing information, contraindications, and dosing guidelines in the manufacturer’s package insert or official clinical references (e.g., Lexicomp, UpToDate) before prescribing or administering medication.