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# Rizatriptan ## Overview Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It is available as standard tablets and orally disintegrating tablets (ODT). ## Primary Indications Acute treatment of migraine, with or without aura, in adults and pediatric patients (aged 6 to 17 years). ## Adult Dosing * **Initial Dose:** 5 mg or 10 mg. * **Frequency:** If migraine recurs or no response, a second dose may be taken at least 2 hours after the first. * **Maximum Dose:** 30 mg in any 24-hour period. * **ODT Administration:** Place on the tongue and allow to dissolve; no liquid is required. ## Pediatric Dosing Based on body weight: * **Weight < 40 kg:** 5 mg. * **Weight ≥ 40 kg:** 10 mg. * **Frequency:** Single dose only; safety/efficacy of a second dose in children has not been established. ## Dose Adjustments * **Renal/Hepatic Impairment:** Use with caution. * **Concomitant Propranolol:** Max dose is 5 mg (as propranolol increases rizatriptan plasma concentrations). ## Contraindications * History of ischemic heart disease (MI, angina, silent ischemia). * History of coronary artery vasospasm (Prinzmetal’s angina). * Wolff-Parkinson-White syndrome or arrhythmias associated with accessory conduction pathways. * History of stroke or transient ischemic attack (TIA). * Peripheral vascular disease. * Ischemic bowel disease. * Severe hepatic or renal impairment. * Uncontrolled hypertension. * Administration within 24 hours of another 5-HT1 agonist or ergot-type medication. * Administration within 2 weeks of MAO inhibitors. ## Adverse Effects * **Common:** Dizziness, somnolence, paresthesia, fatigue, dry mouth, nausea. * **Serious:** Coronary vasospasm/myocardial ischemia, serotonin syndrome (especially with SSRIs/SNRIs), hypertensive crisis, seizures. ## Key Drug Interactions * **MAOIs:** Contraindicated; risk of serotonin syndrome and increased rizatriptan levels. * **Propranolol:** Increases rizatriptan AUC (requires dose limit). * **SSRIs/SNRIs:** Potential risk for serotonin syndrome; monitor clinical status. * **Ergot alkaloids:** Separate administration by at least 24 hours due to additive vasospastic effects. ## Monitoring * Monitor blood pressure periodically. * Assess for chest/jaw pain or signs of serotonin syndrome (agitation, tachycardia, hyperreflexia). * Evaluate headache frequency to monitor for medication-overuse headache. ## Clinical Pearls * Rizatriptan ODT is not bioequivalent to the standard tablet; they may have slight differences in absorption rates. * Triptans are most effective when taken at the onset of headache symptoms. * Patients with significant cardiovascular risk factors should undergo a cardiovascular evaluation before the first dose. * Local institutional protocols may vary regarding pediatric use; always verify weight-based restrictions. *** *Disclaimer: This information is for educational purposes only. Clinical practice guidelines and prescribing information change frequently. Always consult the most current official package insert or local institutional pharmacy protocols before prescribing or administering medication.*