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# Rizatriptan ## Overview Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist used for the acute treatment of migraine headaches with or without aura. It acts via cranial vessel vasoconstriction and inhibition of proinflammatory neuropeptide release. ## Primary Indications Acute treatment of migraine attacks in adults and pediatric patients (aged 6 to 17 years). ## Adult Dosing * **Standard dose:** 5 mg or 10 mg orally. * **Frequency:** May repeat after 2 hours if migraine persists. * **Maximum daily dose:** 30 mg in a 24-hour period. * **Administration:** Orally disintegrating tablets (ODT) must be placed on the tongue and allowed to dissolve; water is not required. ## Pediatric Dosing * **Weight < 40 kg:** 5 mg single dose. * **Weight ≥ 40 kg:** 10 mg single dose. * **Maximum daily dose:** Only one dose should be administered in a 24-hour period for pediatric patients; safety of a second dose has not been established. ## Dose Adjustments * **Patients taking Propranolol:** Rizatriptan dose should be limited to 5 mg (maximum 15 mg/24 hours) due to increased rizatriptan plasma concentrations. * **Renal/Hepatic Impairment:** No specific adjustment is mandated by labeling, but use with caution in severe impairment. ## Contraindications * History of ischemic heart disease (e.g., myocardial infarction, angina). * Coronary artery vasospasm (Prinzmetal’s angina). * History of stroke or transient ischemic attack (TIA). * Peripheral vascular disease. * Uncontrolled hypertension. * Hemiplegic or basilar migraine. * MAO inhibitor use within the past 14 days. * Within 24 hours of another 5-HT1 agonist or ergotamine-type medication. ## Adverse Effects * **Common:** Dizziness, somnolence, paresthesia, xerostomia, fatigue, and sensations of tightness/pressure in the chest or throat. * **Serious:** Coronary vasospasm, myocardial infarction, arrhythmias, serotonin syndrome (if used with SSRIs/SNRIs), and medication overuse headache. ## Key Drug Interactions * **MAO Inhibitors:** Risk of severe serotonin toxicity. * **Propranolol:** Increases rizatriptan AUC (requires dose reduction). * **SSRIs/SNRIs:** Potential risk of serotonin syndrome; monitor clinical status. * **Ergot alkaloids/Other Triptans:** Do not co-administer; wait at least 24 hours between doses to avoid cumulative vasospastic effects. ## Monitoring * **Cardiac:** Assess baseline cardiovascular risk prior to prescribing in patients with multiple risk factors. * **Efficacy:** Monitor for response to treatment; consider alternative therapy if no response to 10 mg dose. * **Serotonin Syndrome:** Monitor for agitation, autonomic instability, and neuromuscular changes (especially if on adjunctive serotonergic meds). ## Clinical Pearls * Rizatriptan is one of the faster-acting oral triptans due to its pharmacokinetic profile. * The risk of "triptan sensations" (tightness/heaviness in chest/neck) is generally non-cardiac in origin, but must be clinically differentiated from ischemic angina during the initial consultation. * Patients should be counseled that triptans are for acute rescue only and are not indicated for migraine prophylaxis. * ODT formulations contain phenylalanine; avoid in patients with phenylketonuria (PKU). *** *Disclaimer: This information is for educational purposes only. Always consult current, full FDA-approved prescribing information or institutional clinical protocols before making prescribing or dosing decisions.*