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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.
## Primary Indications
* Acute treatment of migraine with or without aura in adults and pediatric patients (6–17 years).
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg orally.
* **Repeat Dose:** If migraine recurs after initial relief, a second dose may be taken after at least 2 hours.
* **Maximum Dose:** 30 mg in a 24-hour period.
* *Note:* The 5 mg dose may provide a lower incidence of side effects.
## Pediatric Dosing (6–17 Years)
* **Patients < 40 kg:** 5 mg single dose.
* **Patients ≥ 40 kg:** 10 mg single dose.
* **Maximum Dose:** Only one dose should be administered in a 24-hour period. Safety of repeated dosing in pediatric patients has not been adequately established.
## Dose Adjustments
* **Renal Impairment:** No specific adjustment required.
* **Hepatic Impairment:** For patients with mild-to-moderate hepatic impairment, use the 5 mg dose. Avoid in severe hepatic impairment.
* **Drug Interactions:** Patients taking propranolol (which increases rizatriptan plasma concentrations) should use the 5 mg dose. Maximum dose in these patients should not exceed 15 mg in 24 hours.
## Contraindications
* History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or MI.
* History of stroke or transient ischemic attack (TIA).
* Peripheral vascular disease or ischemic bowel disease.
* Uncontrolled hypertension.
* 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, and dry mouth.
* **Serious:** Coronary artery vasospasm, myocardial infarction, arrhythmias, and serotonin syndrome (especially when combined with SSRIs/SNRIs).
## Key Drug Interactions
* **Propranolol:** Increases rizatriptan exposure; dose limit applies.
* **MAOIs:** Significantly increase serum concentrations of rizatriptan; contraindicated.
* **SSRIs/SNRIs:** Potential risk of serotonin syndrome; monitor for symptoms (confusion, tremor, tachycardia).
* **Ergot derivatives:** Risk of prolonged vasospastic reactions; avoid concurrent use.
## Monitoring
* Monitor cardiovascular status in patients with risk factors for coronary artery disease (postmenopausal women, men >40, uncontrolled HTN, hyperlipidemia).
* Monitor for signs of serotonin syndrome.
* Assess frequency of use to prevent medication-overuse headache (limit use to ≤10 days per month).
## Clinical Pearls
* The orally disintegrating tablet (ODT) does not require water; instruct patients to place it on the tongue, allow it to dissolve, and swallow with saliva.
* Rizatriptan is not indicated for prophylactic migraine therapy or for the management of hemiplegic or basilar migraine.
* If the first dose fails to provide relief, a second dose should not be taken for that same attack unless specified by a provider.
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**Disclaimer:** This information is for educational purposes only. Always consult current, full prescribing information and local institutional clinical protocols before prescribing or administering medication.
