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# Rizatriptan ## Overview Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist used for the acute treatment of migraine. It exhibits higher oral bioavailability than sumatriptan. ## Primary Indications Acute treatment of migraine, with or without aura, in adults and pediatric patients (aged 6 to 17 years). ## Adult Dosing Standard dose: 5 mg or 10 mg orally. If migraine persists or returns, the dose may be repeated after 2 hours. Maximum dose: 30 mg in a 24-hour period. ## Pediatric Dosing Patients 6 to 17 years old: * Weight < 40 kg: 5 mg single dose. * Weight ≥ 40 kg: 10 mg single dose. * Maximum dose: A single dose per 24-hour period. Safety and efficacy of a second dose have not been established. ## Dose Adjustments For patients taking propranolol or with moderate renal/hepatic impairment: * Reduce dose to 5 mg; maximum 15 mg in 24 hours. * Propranolol increases plasma concentrations of rizatriptan by approximately 70%. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s), 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-type medication. * Concomitant use within 14 days of a monoamine oxidase inhibitor (MAOI). ## Adverse Effects * Common: Dizziness, somnolence, paresthesia, and fatigue. * "Triptan sensations": Chest tightness, neck/throat pressure, or heaviness (usually non-cardiac, but warrants evaluation if persistent or severe). * Rare: Coronary vasospasm, arrhythmias, myocardial infarction, or serotonin syndrome. ## Key Drug Interactions * Propranolol: Inhibits metabolism; requires dose reduction. * SSRIs/SNRIs: Risk of serotonin syndrome (theoretical; clinical significance remains debated). * MAOIs: Concomitant use is strictly contraindicated. * Ergot Alkaloids: Increased risk of vasospastic reactions; avoid within 24 hours. ## Monitoring * Monitor cardiovascular status in patients with multiple risk factors (postmenopausal women, men >40, uncontrolled hypertension, diabetes) upon first dose. * Assess for overuse (medication-overuse headache) if used >10 days per month. ## Clinical Pearls * Oral disintegrating tablets (ODT) should be placed on the tongue and allowed to dissolve; no water is required. * Efficacy is maximized if taken as soon as head pain begins. * The ODT formulation contains phenylalanine; use with caution in patients with phenylketonuria. *** **Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Prescribing practices may vary based on local protocols and individual patient health status. Always verify current prescribing information and safety guidelines against the manufacturer's official labeling (e.g., FDA-approved package inserts) or clinical primary resources (e.g., Lexicomp, UpToDate) before prescribing or administering medication.