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# Rizatriptan ## Overview Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist (triptan) used for the acute treatment of migraine headaches. It works by constricting intracranial blood vessels and inhibiting the release of pro-inflammatory neuropeptides. ## Primary Indications Acute treatment of migraine attacks with or without aura in adults and pediatric patients (6 to 17 years). Not indicated for migraine prophylaxis. ## Adult Dosing Standard dose is 5 mg or 10 mg taken orally at the onset of migraine. If the headache recurs after initial relief, a second dose may be taken after at least 2 hours. **Maximum dose:** 30 mg in a 24-hour period. ## Pediatric Dosing Weight-based dosing (for patients 6 to 17 years): * **Weight < 40 kg:** 5 mg dose. * **Weight ≥ 40 kg:** 10 mg dose. May repeat once after 2 hours if needed (maximum 2 doses per 24-hour period). Note: Pediatric safety/efficacy data is specifically for the tablet formulation; ODT (orally disintegrating tablet) data is extrapolated. ## Dose Adjustments * **Propranolol:** If the patient is taking propranolol, the rizatriptan dose must be limited to 5 mg (maximum 15 mg in 24 hours) due to increased rizatriptan plasma concentrations. * **Renal/Hepatic Impairment:** Use with caution; consider the lowest effective dose. ## 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). * Peripheral vascular disease or ischemic bowel disease. * Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication. * Use within 2 weeks of MAO inhibitors. ## Adverse Effects * **Common:** Paresthesia, somnolence, dizziness, fatigue, and sensations of pressure, pain, or tightness in the chest/neck/throat. * **Serious:** Coronary artery vasospasm, myocardial infarction, arrhythmias, and serotonin syndrome (especially when combined with SSRIs/SNRIs). ## Key Drug Interactions * **MAO Inhibitors:** Risk of serotonin syndrome and increased rizatriptan levels. * **SSRIs/SNRIs:** Potential increased risk of serotonin syndrome. * **Propranolol:** Increases rizatriptan AUC (requires dose reduction). * **Ergots:** Potential for additive vasoconstriction; avoid concurrent use. ## Monitoring * Monitor blood pressure periodically at initiation, especially in patients with cardiovascular risk factors. * Assess for chest/neck tightness; evaluate for cardiac ischemia if symptoms are severe or persistent. * Monitor for signs of serotonin syndrome if used with SSRIs/SNRIs. ## Clinical Pearls * The ODT formulation does not require water; monitor pediatric patients to ensure they do not "chew" the tablet. * Rizatriptan is one of the faster-acting triptans due to its pharmacokinetic profile. * Limit use to ≤ 10 days per month to prevent medication-overuse headache (MOH). * If the first dose provides no relief, it is generally recommended not to take a second dose for the same attack. *** *Disclaimer: This information is for educational purposes only. Always verify dosing, contraindications, and drug-drug interactions against current institutional protocols, the package insert, and clinical decision support tools before prescribing or administering medication.*