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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It acts 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 6–17 years). Not indicated for migraine prophylaxis or management of hemiplegic or basilar migraine.
## Adult Dosing
* **Standard dose:** 5 mg or 10 mg taken at the onset of migraine.
* **Administration:** Orally disintegrating tablets (ODT) should be placed on the tongue and allowed to dissolve; no water is required.
* **Repeat dose:** May repeat dose after 2 hours if symptoms return or persist.
* **Maximum dose:** 30 mg in a 24-hour period.
## Pediatric Dosing
Dosing is based on body weight.
* **Patients <40 kg:** 5 mg single dose.
* **Patients ≥40 kg:** 10 mg single dose.
* **Repeat dose:** May repeat after 2 hours if needed.
* **Maximum dose:** Limit to one dose per 24 hours in children; use of a second dose has not been systematically evaluated.
## Dose Adjustments
* **Propranolol:** Concomitant use increases rizatriptan plasma concentrations. Limit dose to 5 mg (max 15 mg/24 hours).
* **Renal/Hepatic Impairment:** Use with caution; consider 5 mg dose for patients with moderate hepatic or renal impairment.
## Contraindications
* History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or history of myocardial infarction.
* Uncontrolled hypertension.
* History of stroke or transient ischemic attack (TIA).
* Peripheral vascular disease or ischemic bowel disease.
* Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication.
* MAO inhibitor use within the past 2 weeks.
## Adverse Effects
* **Common:** Paresthesia, dizziness, somnolence, fatigue, and dry mouth.
* **Serious:** Coronary vasospasm, arrhythmias, myocardial infarction, Serotonin Syndrome (when used with serotonergic agents), and medication overuse headache.
## Key Drug Interactions
* **MAO Inhibitors:** Risk of severe serotonin toxicity.
* **SSRI/SNRI antidepressants:** Potential risk of serotonin syndrome; monitor for symptoms (agitation, tremor, hyperreflexia).
* **Propranolol:** Significantly increases rizatriptan exposure.
## Monitoring
* Monitor cardiovascular status in patients with risk factors for coronary artery disease.
* Assess frequency of use to identify potential medication overuse headache (generally defined as >10 days per month).
## Clinical Pearls
* Clinical efficacy is generally higher if taken at the earliest onset of migraine symptoms.
* If a patient fails to respond to the first dose of 10 mg, efficacy of a repeat dose in the same attack is unlikely; assess alternative therapies.
* Avoid in patients with Wolf-Parkinson-White syndrome associated with arrhythmias.
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*Disclaimer: This information is for educational purposes only. Always consult the latest FDA-approved prescribing information or institutional clinical guidelines before initiating therapy.*
