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# Rizatriptan ## Overview Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It causes cranial vessel constriction and inhibits the release of pro-inflammatory neuropeptides. ## Primary Indications Acute treatment of migraine attacks with or without aura in adults and pediatric patients. ## Adult Dosing * **Initial Dose:** 5 mg or 10 mg. * **Frequency:** If symptoms return, a second dose may be taken after at least 2 hours. * **Maximum Dose:** 30 mg in a 24-hour period. * *Note:* 5 mg doses may be used to minimize side effects; patients with a history of poor response to other triptans may require the 10 mg dose. ## Pediatric Dosing * **Ages 6 to 17 years:** * Weight <40 kg: 5 mg dose. * Weight ≥40 kg: 10 mg dose. * **Frequency:** Single dose only; efficacy of a second dose has not been established in pediatric populations. ## Dose Adjustments * **Propranolol:** Patients receiving propranolol must use the 5 mg dose (maximum 15 mg/24 hours) due to increased rizatriptan plasma concentrations. * **Renal/Hepatic Impairment:** No specific adjustment required; however, use with caution in severe hepatic impairment. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or MI. * Uncontrolled hypertension. * History of stroke or transient ischemic attack (TIA). * Peripheral vascular disease. * Hemiplegic or basilar migraine. * Concomitant use within 2 weeks of MAO inhibitors. * Concomitant use within 24 hours of other 5-HT1 agonists or ergotamine-type medications. ## Adverse Effects * **Common:** Paresthesia, somnolence, dizziness, fatigue, and chest tightness/heaviness. * **Serious:** Coronary vasospasm, arrhythmias, myocardial infarction, serotonin syndrome, and medication-overuse headache. ## Key Drug Interactions * **MAO Inhibitors:** Risk of serotonin syndrome and increased rizatriptan levels. * **SSRI/SNRI:** Increased risk of serotonin syndrome. * **Propranolol:** Increased bioavailability of rizatriptan. * **Ergot-containing drugs:** Increased risk of prolonged vasospastic reactions. ## Monitoring * Monitor for signs of serotonin syndrome (agitation, tachycardia, hyperreflexia). * Assess cardiovascular status in patients with cardiovascular risk factors (e.g., postmenopausal women, men >40, uncontrolled HTN) before initial use. ## Clinical Pearls * **Administration:** Orally disintegrating tablets (ODT) do not require water; the blister pack should be opened with dry hands. * **Efficacy:** Effectiveness is best if administered as soon as migraine symptoms begin. * **Consistency:** If the patient does not respond to the first dose, the diagnosis of migraine should be re-evaluated before attempting a second dose. * **Medication Overuse:** Advise patients to limit use to fewer than 10 days per month to prevent medication-overuse headache. *** *Disclaimer: This information is for educational purposes only. Prescribing information and local protocols can change. Always consult current clinical guidelines and the manufacturer’s package insert before prescribing or administering medication.*