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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT$_{1B/1D}$) 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 (6–17 years). Not indicated for migraine prophylaxis or hemiplegic/basilar migraines.
## Adult Dosing
* **Standard dose:** 5 mg or 10 mg orally at onset of migraine.
* **Redosing:** If symptoms recur or if no response occurs, a second dose may be taken after a minimum of 2 hours.
* **Maximum daily dose:** 30 mg in a 24-hour period.
## Pediatric Dosing
* **Patients 6 to 17 years (< 40 kg):** 5 mg single dose.
* **Patients 6 to 17 years (≥ 40 kg):** 10 mg single dose.
* **Maximum dose:** Only one dose per 24-hour period is established for pediatric use.
## Dose Adjustments
* **Propranolol:** Patients taking propranolol should receive the 5 mg dose. The maximum daily dose is 15 mg (three 5 mg doses) due to increased blood levels of rizatriptan.
* **Renal/Hepatic Impairment:** No specific data; use caution in severe hepatic impairment.
## Contraindications
* History of ischemic heart disease (e.g., history of MI, angina, silent ischemia).
* Coronary artery vasospasm (Prinzmetal's angina).
* Wolff-Parkinson-White syndrome/arrhythmias associated with accessory conduction pathways.
* History of stroke or transient ischemic attack (TIA).
* Peripheral vascular disease.
* Uncontrolled hypertension.
* Administration within 24 hours of another triptan or ergotamine-type medication.
* Current or usage within 14 days of a Monoamine Oxidase Inhibitor (MAOI).
## Adverse Effects
* **Common:** Paresthesia, dizziness, somnolence, fatigue, nausea, and sensations of pressure, pain, or tightness in the chest/neck/jaw.
* **Serious:** Myocardial infarction, arrhythmias, coronary artery vasospasm, and serotonin syndrome (especially when combined with SSRIs/SNRIs).
## Key Drug Interactions
* **MAOIs:** May significantly increase rizatriptan plasma concentrations.
* **Propranolol:** Increases rizatriptan exposure; requires dose modification.
* **SSRIs/SNRIs:** Potential risk of serotonin syndrome; monitor for symptoms (agitation, tachycardia, hyperreflexia).
* **Ergot alkaloids:** Increased risk of vasospastic reactions; avoid concurrent use.
## Monitoring
* Monitor cardiovascular status in patients with risk factors for coronary artery disease (post-menopausal women, men >40, patients with uncontrolled HTN, hyperlipidemia, or diabetes).
* Assess for chest pain or signs of serotonin syndrome following administration.
## Clinical Pearls
* **Oral Disintegrating Tablets (ODT):** Use dry hands to peel back the blister pack. The tablet dissolves in saliva and does not require water, providing a convenience advantage for patients with migraine-associated nausea.
* **Consistency:** Efficacy may vary between individual migraine attacks.
* **Medication Overuse Headache (MOH):** Excessive use (typically ≥10 days per month) of triptans can lead to chronic daily headache.
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*Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Always verify current prescribing information, institutional protocols, and patient-specific factors before administration.*
