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# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It acts via cranial vessel vasoconstriction and inhibition of pro-inflammatory neuropeptide release. 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 (age 6–17).
## Adult Dosing
* **Standard dose:** 5 mg or 10 mg at the onset of migraine.
* **Max dose:** 30 mg in a 24-hour period.
* **Redosing:** If headache recurs, a second dose may be taken at least 2 hours after the first dose. Do not exceed 30 mg per 24 hours.
## Pediatric Dosing (6–17 years)
* **Weight < 40 kg:** 5 mg single dose.
* **Weight ≥ 40 kg:** 10 mg single dose.
* **Max dose:** One dose per 24-hour period. Safety of multiple doses in pediatric patients has not been adequately established.
## Dose Adjustments
* **Propranolol:** Concomitant use increases rizatriptan plasma concentrations. Limit rizatriptan dose to 5 mg (max 15 mg/24 hours).
* **Renal/Hepatic Impairment:** No specific adjustment defined, though use with caution in severe impairment; generally avoid in severe hepatic failure.
## Contraindications
* History of ischemic heart disease, coronary artery vasospasm (Prinzmetal angina), or 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-containing 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, myocardial infarction, serotonin syndrome (when combined with SSRIs/SNRIs), and arrhythmias.
## Key Drug Interactions
* **MAOIs:** Potential for significant increase in exposure; contraindicated.
* **Propranolol:** Increases rizatriptan blood levels (requires dose reduction).
* **SSRIs/SNRIs:** Increased risk of serotonin syndrome; monitor for symptoms (agitation, tremor, hyperreflexia).
* **Ergot derivatives:** Additive vasospastic effects; separate dosing by at least 24 hours.
## Monitoring
* **Cardiovascular:** Monitor blood pressure, especially in patients with cardiovascular risk factors, particularly after the first dose.
* **Neurological:** Monitor for symptoms of serotonin syndrome if taken with other serotonergic agents.
* **Efficacy:** Keep a headache diary to track frequency, recovery time, and response to treatment.
## Clinical Pearls
* **ODT formulation:** Place on the tongue and allow to dissolve; oral administration without liquid is sufficient (does not necessarily require water for swallowing).
* **Timing:** Administer as soon as migraine symptoms begin; efficacy is significantly reduced if delayed.
* **Chest Pain:** Patients describing "chest tightness" must be evaluated for cardiac ischemia, although this is often a non-cardiac triptan-related sensory effect.
* **Medication Overuse Headache (MOH):** Limit use to < 10 days per month to prevent rebound headaches.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical protocols and safety data may change; always verify current prescribing information in a trusted clinical resource (e.g., Lexicomp, UpToDate) or the manufacturer's package insert before prescribing or administering medication.
