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# Rizatriptan ## Overview Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist (triptan) that 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 (aged 6 to 17 years). ## Adult Dosing * **Initial Dose:** 5 mg or 10 mg orally. * **Max Dose:** 30 mg in a 24-hour period. * **Redosing:** If headache recurs after initial relief, a second dose may be taken at least 2 hours after the first. * **Note:** Use the 5 mg dose for patients taking concomitant propranolol or those with mild-to-moderate hepatic/renal impairment. ## Pediatric Dosing * **Patients < 40 kg:** 5 mg as a single dose. * **Patients ≥ 40 kg:** 10 mg as a single dose. * **Redosing:** Do not administer a second dose within 24 hours in pediatric patients. Safety of a second dose has not been established. ## Dose Adjustments * **Propranolol:** Reduce rizatriptan dose to 5 mg (max 15 mg/24 hours) due to increased rizatriptan plasma concentrations. * **Hepatic/Renal Impairment:** Consider 5 mg dose for patients with mild-to-moderate impairment. Avoid use in severe hepatic impairment. ## Contraindications * History of ischemic heart disease (coronary artery vasospasm, silent ischemia, MI). * History of stroke or transient ischemic attack (TIA). * Peripheral vascular disease or ischemic bowel disease. * Uncontrolled hypertension. * Hemiplegic or basilar migraine. * Administration within 24 hours of another 5-HT1 agonist or ergot-type medication. * Administration within 2 weeks of MAO inhibitors. ## Adverse Effects * **Common:** Paresthesia, dizziness, somnolence, fatigue, and pain/pressure sensations (chest or neck tightness). * **Rare/Serious:** Serious cardiac events (arrhythmias, MI), serotonin syndrome, and medication-overuse headache. ## Key Drug Interactions * **MAO Inhibitors:** Risk of severe serotonin toxicity. * **SSRIs/SNRIs:** Increased risk of serotonin syndrome; monitor clinical status. * **Propranolol:** Increases rizatriptan levels; requires dose reduction. * **Ergotamines:** Potential for additive vasoconstriction; separate by at least 24 hours. ## Monitoring * Monitor blood pressure periodically during initial use in patients with cardiovascular risk factors. * Monitor for signs of serotonin syndrome (agitation, tachycardia, hyperreflexia). * Assess for overuse if patient requires head-of-month frequency treatment. ## Clinical Pearls * **Effectiveness:** Rizatriptan typically has a faster onset of action than other triptans due to higher bioavailability. * **Administration:** Orally disintegrating tablets (ODT) do not require water; instruct patient to place on tongue and allow to dissolve. * **Limitations:** Triptans are not indicated for cluster headaches or hemiplegic migraines. * **Cardiovascular Safety:** If cardiac risk factors exist, consider a baseline ECG or cardiovascular evaluation before the first dose. *** *Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Always verify current prescribing information, institutional protocols, and specific patient contraindications before prescribing or administering medication.*