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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It exhibits higher oral bioavailability than many other triptans and is available as an oral tablet and an orally disintegrating tablet (ODT).
## Primary Indications
Acute treatment of migraine with or without aura in adults and pediatric patients.
## Adult Dosing
Standard dose is 5 mg or 10 mg at the onset of migraine. If the headache recurs after 2 hours, a second dose may be taken. Maximum dose is 30 mg in a 24-hour period.
## Pediatric Dosing
* **6 to 17 years (weight 27 kg to <40 kg):** 5 mg single dose.
* **6 to 17 years (weight ≥40 kg):** 10 mg single dose.
* **Note:** Efficacy and safety of a second dose in pediatric patients have not been established. Data are limited; consult pediatric-specific institutional protocols.
## Dose Adjustments
* **Propranolol:** Reduce rizatriptan dose to 5 mg (maximum 15 mg/24 hours) due to increased plasma concentrations.
* **Hepatic/Renal Impairment:** Exercise caution; consider 5 mg dose for mild-to-moderate impairment. Avoid in severe hepatic impairment.
## Contraindications
History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), history of stroke or TIA, peripheral vascular disease, uncontrolled hypertension, and severe hepatic/renal impairment. Do not use within 24 hours of another 5-HT1 agonist or ergotamine-type medication. Do not use within 2 weeks of MAO inhibitors.
## Adverse Effects
Common: Paresthesia, dizziness, somnolence, fatigue, and sensations of pressure, pain, or tightness in the chest/neck/throat (often non-cardiac, but must be assessed). Rare: Serotonin syndrome, cardiac arrhythmias, and myocardial infarction.
## Key Drug Interactions
* **Propranolol:** Significantly increases rizatriptan exposure.
* **SSRIs/SNRIs:** Theoretical risk of serotonin syndrome; monitor for symptoms (agitation, tachycardia, hyperreflexia).
* **MAO Inhibitors:** Absolutely contraindicated.
## Monitoring
Monitor blood pressure intermittently in patients with cardiovascular risk factors. Assess for signs of serotonin syndrome if combined with serotonergic agents. If chest pain or tightness is severe or persistent, rule out ischemic changes before subsequent doses.
## Clinical Pearls
* ODT formulation: The blister pack must be kept dry; peel back the blister—do not push the tablet through the foil. No water is required for ingestion.
* Wait at least 2 hours between doses.
* Efficacy is maximized when administered as soon as possible after migraine onset.
* Overuse of triptans can lead to medication overuse headache (MOH); limit use to fewer than 10 days per month.
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*Disclaimer: This information is for educational purposes. Always verify current prescribing information, institutional guidelines, and drug labels via databases like Lexicomp or UpToDate before prescribing or administering medication.*
