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# Rizatriptan ## Overview Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist used for the acute treatment of migraine. It works via cranial vessel vasoconstriction and inhibition of pro-inflammatory neuropeptide release. ## Primary Indications Acute treatment of migraine attacks with or without aura in adults and pediatric patients (aged 6 to 17 years). ## Adult Dosing * **Initial Dose:** 5 mg or 10 mg at the onset of migraine. * **Repeat Dose:** If symptoms persist or return, a second dose may be administered after at least 2 hours. * **Maximum Dose:** 30 mg in a 24-hour period. ## Pediatric Dosing * **Weight < 40 kg:** 5 mg single dose. * **Weight ≥ 40 kg:** 10 mg single dose. * **Note:** Efficacy and safety for repeat dosing in pediatric patients have not been established; limited to a single dose per 24 hours in most clinical settings. ## Dose Adjustments * **Propranolol Users:** Dosage must be limited to 5 mg maximum per dose, with a maximum of 15 mg in 24 hours, due to increased rizatriptan plasma concentrations. * **Hepatic/Renal Impairment:** Use with caution in patients with mild to moderate impairment; use is generally not recommended in severe hepatic impairment. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal's angina), or myocardial infarction. * 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 ergot-type medication. * Concomitant use or use within 2 weeks of discontinuing MAO inhibitors. ## Adverse Effects * **Common:** Dizziness, somnolence, paresthesia, fatigue, and dry mouth. * **Serious:** Coronary artery vasospasm, myocardial infarction, arrhythmias, and serotonin syndrome (rare). ## Key Drug Interactions * **Propranolol:** Increases rizatriptan exposure significantly. * **SSRIs/SNRIs:** Risk of serotonin syndrome; monitor closely. * **Ergot alkaloids:** Increased risk of prolonged vasospastic reactions; avoid within 24 hours of rizatriptan. * **MAO Inhibitors:** Risk of significant hypertension and serotonin syndrome. ## Monitoring * Monitor blood pressure periodically in patients with cardiovascular risk factors. * Assess for chest pain, pressure, or tightness (potentially indicative of vasospastic events). * Observe for signs/symptoms of serotonin syndrome if combined with serotonergic agents. ## Clinical Pearls * The orally disintegrating tablet (ODT) should be placed on the tongue and allowed to dissolve; no water is required. * Rizatriptan is not indicated for the prevention of migraine or the treatment of hemiplegic/basilar migraine. * Medication Overuse Headache (MOH) can occur with frequent use (e.g., ≥10 days per month); advise patients to limit use. * Effectiveness is higher if taken at the earliest onset of pain. *** *Disclaimer: This information is for educational purposes only. Always verify current prescribing information, institutional protocols, and patient-specific factors via official drug resources (e.g., Lexicomp, FDA-approved labels) before prescribing or administering medication.*