Please check your internet connection and try again.
# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It exhibits higher oral bioavailability than sumatriptan and is available as a conventional tablet and an orally disintegrating tablet (ODT).
## Primary Indications
Acute treatment of migraine with or without aura in adults and pediatric patients.
## 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 taken at least 2 hours after the initial dose.
* **Maximum Daily Dose:** 30 mg in a 24-hour period.
## Pediatric Dosing
* **Weight < 40 kg:** 5 mg.
* **Weight ≥ 40 kg:** 10 mg.
* **Repeat Dose:** A second dose may be administered at least 2 hours after the initial dose.
* **Max Daily Dose:** Limited to one dose per 24-hour period for patients < 40 kg; two doses per 24-hour period for patients ≥ 40 kg.
## Dose Adjustments
* **Patients on Propranolol:** The dose must be reduced to 5 mg (max 15 mg/24 hours) due to increased rizatriptan plasma concentrations.
* **Renal/Hepatic Impairment:** No specific adjustment required; however, caution is advised 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.
* Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication.
* Use within 2 weeks of discontinuing a monoamine oxidase inhibitor (MAOI).
## Adverse Effects
* **Common:** Paresthesia, somnolence, dizziness, fatigue, and sensations of pressure, pain, or tightness in the chest/neck/throat.
* **Serious:** Coronary vasospasm, arrhythmias, myocardial infarction, serotonin syndrome (if combined with SSRIs/SNRIs), and medication-overuse headache.
## Key Drug Interactions
* **MAOIs:** Risk of highly elevated rizatriptan levels; contraindicated.
* **Propranolol:** Increases rizatriptan AUC by ~70%.
* **SSRIs/SNRIs:** Potential risk of serotonin syndrome; monitor for symptoms (agitation, tachycardia, hyperreflexia).
* **Ergot alkaloids:** Increased risk of prolonged vasospastic reactions; avoid within 24 hours.
## Monitoring
* Monitor cardiovascular status in patients with risk factors for coronary artery disease (post-menopausal women, diabetic patients, smokers, men > 40).
* Assess for chest pain or symptoms of serotonin syndrome following the first dose.
## Clinical Pearls
* **ODT Formulation:** The ODT should be placed on the tongue and allowed to dissolve; no liquid is required. It is not faster-acting than the standard tablet.
* **Efficacy:** If there is no response to the first dose, the diagnosis of migraine should be confirmed before attempting a second dose or adding other medications.
* **Medication-Overuse:** Limit use to < 10 days per month to avoid medication-overuse headache.
***
*Disclaimer: This information is for educational purposes and does not replace medical judgment. Clinical protocols vary by institution. Always verify current prescribing information and patient-specific factors via official drug resources (e.g., FDA labels, Lexicomp, or Micromedex) before prescribing or administering medication.*
