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# Rizatriptan ## Overview Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist (triptan) used for the abortive treatment of migraine headaches with or without aura. It is available as conventional tablets and orally disintegrating tablets (ODT). ## Primary Indications Acute treatment of migraine headaches in adults and pediatric patients (aged 6 to 17 years). ## Adult Dosing Standard dose: 5 mg or 10 mg orally at the onset of migraine. If migraine recurs after initial relief, a second dose may be administered at least 2 hours after the first. Maximum dose: 30 mg in any 24-hour period. ## Pediatric Dosing Patients 6 to 17 years old: * Weight < 40 kg: 5 mg dose. * Weight ≥ 40 kg: 10 mg dose. Maximum dose: A single dose per 24-hour period (safety of a second dose has not been established in clinical trials for this population). ## Dose Adjustments * **Renal/Hepatic Impairment:** No specific adjustment required; use caution in severe hepatic impairment. * **Propranolol Use:** Patients taking propranolol should use the 5 mg dose due to potential for increased rizatriptan plasma concentrations. Maximum dose in these patients is 15 mg per 24 hours. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or history of 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. * Administration within 2 weeks of monoamine oxidase (MAO) inhibitor therapy. * Severe hepatic or renal impairment (manufacturer labeling suggests caution). ## Adverse Effects * Common: Dizziness, drowsiness, asthenia/fatigue, and paresthesia. * Rare but 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 risk of serotonin syndrome; monitor clinical status. * **Propranolol:** Increases rizatriptan bioavailability (limit dose to 5 mg). * **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 "triptan sensations" (chest/throat tightness or pressure); ensure these are not cardiac in origin. * Monitor for signs of serotonin syndrome. ## Clinical Pearls * The ODT form does not require water; the blister pack should be dry and opened with clean, dry hands. * Rizatriptan is not indicated for the prophylaxis of migraine or for the treatment of hemiplegic or basilar migraine. * If the first dose fails to provide relief, do not take a second dose for the same attack; evaluate the diagnosis. * Excessive use of triptans (generally >10 days per month) may lead to medication-overuse headache (MOH). *** **Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Prescribing practices and local protocols may vary. Always consult the current manufacturer's package insert or a verified clinical database (e.g., Lexicomp, UpToDate) before prescribing or administering medication.