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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist used for the acute treatment of migraine attacks. It is available as conventional tablets and orally disintegrating tablets (ODT).
## Primary Indications
Acute treatment of migraine with or without aura in adults and pediatric patients.
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg at onset of migraine.
* **Dosing Interval:** If symptoms return, a second dose may be taken at least 2 hours after the first.
* **Maximum Dose:** 30 mg in a 24-hour period.
* **Note:** Use 5 mg for patients taking propranolol or with mild/moderate hepatic/renal impairment.
## Pediatric Dosing
* **Age 6–17 years (weight-based):**
* **Weight < 40 kg:** 5 mg single dose.
* **Weight ≥ 40 kg:** 10 mg single dose.
* **Maximum:** Do not exceed one dose per 24-hour period in pediatric patients.
## Dose Adjustments
* **Propranolol:** Reduce rizatriptan dose to 5 mg (propranolol increases rizatriptan plasma concentrations).
* **Hepatic/Renal Impairment:** Use 5 mg in mild/moderate impairment. Avoid in severe hepatic impairment.
## Contraindications
* History of ischemic heart disease (e.g., angina, MI).
* Coronary vasospasm (Prinzmetal’s angina).
* 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, nausea, fatigue, and dry mouth.
* **Serious:** Coronary artery vasospasm, arrhythmias, myocardial infarction, serotonin syndrome, and hypertension.
## Key Drug Interactions
* **MAO Inhibitors:** Risk of serotonin syndrome and increased rizatriptan levels; avoid concurrent use.
* **Selective Serotonin Reuptake Inhibitors (SSRIs/SNRIs):** Potential risk of serotonin syndrome; monitor closely.
* **Propranolol:** Increases rizatriptan exposure; requires dose reduction.
## Monitoring
* Monitor cardiovascular status in patients with multiple risk factors (first dose should be administered in a medical setting).
* Assess for potential serotonin syndrome if used with other serotonergic agents.
* Monitor for signs of medication overuse headache (MOH) with frequent use.
## Clinical Pearls
* **Administration:** ODT formulation should be placed on the tongue and allowed to dissolve; no liquid is required.
* **Efficacy:** Effectiveness is not established for the treatment of cluster headaches or hemiplegic/basilar migraines.
* **Safety:** Patients with "silent" cardiac risk factors (e.g., post-menopausal women, diabetic patients) should undergo a cardiovascular assessment before initiation.
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**Disclaimer:** This information is for educational purposes only. Clinical protocols and prescribing information may vary by region or institution. Always consult the latest FDA-approved prescribing information or a local clinical pharmacist before finalizing a treatment plan.
