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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin receptor agonist (5-HT1B/1D) used for the acute treatment of migraine. It acts via cranial vessel vasoconstriction and inhibition of pro-inflammatory neuropeptide release.
## Primary Indications
Acute treatment of migraine attacks with or without aura in adults and pediatric patients (aged 6 to 17 years). Not indicated for migraine prophylaxis or hemiplegic/basilar migraine.
## Adult Dosing
Standard dose is 5 mg or 10 mg taken orally at the onset of migraine. If the headache recurs, a second dose may be taken after at least 2 hours. Do not exceed 30 mg in a 24-hour period. Orally disintegrating tablets (ODT) should be placed on the tongue and allowed to dissolve.
## Pediatric Dosing
* **Ages 6 to 17 years (< 40 kg):** 5 mg single dose.
* **Ages 6 to 17 years (≥ 40 kg):** 10 mg single dose.
If the headache does not resolve or recurs, a second dose may be administered after at least 2 hours. Maximum daily dose is limited to one dose in a 24-hour period for pediatric patients.
## Dose Adjustments
For patients taking propranolol, the dose of rizatriptan should be reduced to 5 mg (maximum 15 mg per 24 hours), as propranolol increases rizatriptan plasma concentrations. No specific adjustment is required for mild-to-moderate hepatic or renal impairment; use with caution in severe impairment.
## 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.
* Concomitant use (or within 2 weeks) of MAO inhibitors.
* Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication.
## Adverse Effects
Common: Dizziness, somnolence, paresthesia, and fatigue.
Serious: Coronary artery vasospasm, myocardial ischemia, arrhythmias, serotonin syndrome (when combined with serotonergic drugs), and hypertensive crisis.
## Key Drug Interactions
* **Propranolol:** Increases rizatriptan AUC (reduce dose).
* **SSRIs/SNRIs:** Increased risk of serotonin syndrome.
* **MAO Inhibitors:** Absolutely contraindicated.
* **Ergot-containing drugs:** Additive vasoconstrictive effects; separate administration by at least 24 hours.
## Monitoring
Monitor blood pressure periodically, especially in patients with cardiovascular risk factors. Assess for signs of serotonin syndrome (agitation, tachycardia, hyperreflexia) if used with other serotonergic agents. Observe for signs/symptoms of myocardial ischemia (chest pain, shortness of breath) after the first dose.
## Clinical Pearls
* Rizatriptan ODT does not require water, but the blister pack should be kept in the foil until administration.
* Medication Overuse Headache (MOH) may occur with frequent use (typically ≥10 days per month).
* Efficacy is higher when the medication is taken early in the headache attack cycle.
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*Educational Disclaimer: This information is for educational purposes only. Always consult current, full prescribing information and institutional guidelines before prescribing or administering medication.*
