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# Rizatriptan ## Overview Rizatriptan is a selective 5-HT1B/1D receptor agonist used for the acute treatment of migraine headaches with or without aura. It acts by causing vasoconstriction of intracranial blood vessels and inhibiting the release of pro-inflammatory neuropeptides. ## Primary Indications Acute treatment of migraine attacks. It is not indicated for migraine prophylaxis or the treatment of hemiplegic or basilar migraines. ## Adult Dosing * **Standard dose:** 5 mg or 10 mg orally. * **Administration:** May repeat dose after 2 hours if migraine persists. * **Maximum dose:** 30 mg in a 24-hour period. ## Pediatric Dosing * **Ages 6 to 17 years:** * Weight < 40 kg: 5 mg once. * Weight ≥ 40 kg: 10 mg once. * **Note:** Safety and efficacy for repeat dosing in pediatric patients have not been established; generally limited to a single dose per 24 hours in clinical practice unless otherwise specified by local pediatric neurology protocols. ## Dose Adjustments * **Hepatic Impairment:** Use with caution in mild-to-moderate impairment. * **Renal Impairment:** No specific adjustment required. * **Concurrent Propranolol Use:** Max dose of rizatriptan is 5 mg (total max 15 mg/24 hours) due to increased rizatriptan plasma concentrations. ## Contraindications * History of ischemic heart disease (e.g., angina, myocardial infarction, silent ischemia). * Coronary artery vasospasm (Prinzmetal’s angina). * 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-derivative. * Use within 2 weeks of discontinuing a MAO-A inhibitor. ## Adverse Effects * **Common:** Paresthesia, dizziness, somnolence, fatigue, nausea, and sensations of pressure, pain, or tightness in the throat, neck, or chest. * **Serious:** Coronary artery vasospasm, myocardial infarction, arrhythmias, and serotonin syndrome (especially when combined with SSRIs/SNRIs). ## Key Drug Interactions * **MAO-A Inhibitors:** Significant increase in rizatriptan exposure; contraindicated. * **Propranolol:** Increases rizatriptan blood levels (see Dose Adjustments). * **SSRIs/SNRIs:** Potential risk of serotonin syndrome; monitor for symptoms (agitation, tachycardia, hyperreflexia). * **Ergot-containing drugs:** Additive risk of prolonged vasospastic reactions; wait ≥24 hours between them. ## Monitoring * Monitor cardiovascular status, particularly in patients with risk factors for coronary artery disease. * Monitor for signs of serotonin syndrome. * Assess for medication-overuse headache if used >10 days per month. ## Clinical Pearls * The orally disintegrating tablet (ODT) should be placed on the tongue and allowed to dissolve; no liquid is required. * Patients should be cautioned that "chest pressure" is a common side effect of triptans, but if it is severe, persistent, or suggestive of angina, use must be discontinued and cardiac evaluation initiated. * Effectiveness is higher when the medication is taken early in the migraine attack. *** **Educational Disclaimer:** This information is for educational purposes only and does not serve as medical advice. Dosing and clinical protocols may vary by institution or patient-specific factors. Always verify the most current prescribing information via the manufacturer's package insert or a verified clinical database (e.g., Lexicomp, UpToDate) before prescribing or administering medication.