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# Rizatriptan ## Overview Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist used in 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. ## Adult Dosing * **Initial Dose:** 5 mg or 10 mg at onset of migraine. * **Repeat Dose:** May repeat after 2 hours if migraine persists. * **Maximum Dose:** 30 mg in a 24-hour period. ## Pediatric Dosing * **6 to 17 years (Weight ≥40 kg):** 10 mg single dose. * **6 to 17 years (Weight 20 to <40 kg):** 5 mg single dose. * **Repeat Dose:** If headache recurs, a second dose may be administered at least 2 hours after the first. * **Safety Note:** Do not exceed 2 doses within a 24-hour period. ## Dose Adjustments * **Propranolol:** Patients receiving propranolol must use the 5 mg dose (maximum 15 mg/24 hours) because propranolol significantly increases rizatriptan plasma concentrations. * **Hepatic/Renal Impairment:** Use with caution; no specific dose adjustments are standardized in the package insert, but lower starting doses are often practiced clinically. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal's angina), or myocardial infarction. * Uncontrolled hypertension. * History of stroke or transient ischemic attack (TIA). * Hemiplegic or basilar migraine. * Administration within 24 hours of another 5-HT1 agonist or ergotamine-derivative. * MAO-A inhibitor therapy or use within 2 weeks of discontinuing MAO-A inhibitors. ## Adverse Effects * **Common:** Paresthesia, dizziness, somnolence, fatigue, and dry mouth. * **Serious:** Coronary vasospasm/ischemia, arrhythmias, serotonin syndrome (especially with SSRIs/SNRIs), and hypertensive crisis. ## Key Drug Interactions * **MAO-A Inhibitors:** Do not use concurrently. * **SSRIs/SNRIs:** Risk of serotonin syndrome; monitor for agitation, tremor, and tachycardia. * **Propranolol:** Reduces clearance of rizatriptan; dose-capping required. * **Ergot-containing drugs:** Additive risk of vasospasm; separate by at least 24 hours. ## Monitoring * Monitor blood pressure periodically. * Assess for chest pain, tightness, or pressure after the first dose (cardiac evaluation). * Monitor for signs of serotonin syndrome if used with other serotonergic agents. ## Clinical Pearls * **ODT formulation:** Must be placed on the tongue and allowed to dissolve; no liquid is required. Do not remove from the blister pack until immediately before use. * **Efficacy:** Effectiveness is significantly diminished if taken after the headache is severe; counsel patients to take the medication as soon as headache symptoms begin. * **Medication Overuse Headache (MOH):** Excessive use (typically ≥10 days per month) can lead to rebound headaches. *** *Disclaimer: This information is for educational purposes and does not replace professional medical judgment. Always verify dosing and contraindications against current clinical guidelines and the manufacturer’s official package insert before prescribing or administering medication.*