Please check your internet connection and try again.
# Rizatriptan
## Overview
Rizatriptan is a selective serotonin (5-HT1B/1D) receptor agonist. It induces vasoconstriction of intracranial blood vessels and inhibits the release of pro-inflammatory neuropeptides. It is available as a conventional tablet and an orally disintegrating tablet (ODT).
## Primary Indications
Acute treatment of migraine with or without aura in adults and pediatric patients (aged 6 to 17 years).
## Adult Dosing
Standard dose is 5 mg or 10 mg at the onset of migraine. If the migraine recurs or there is no response after the initial dose, a second dose may be administered at least 2 hours after the first.
*Maximum Daily Dose:* 30 mg in 24 hours.
## Pediatric Dosing
Patients 6 to 17 years of age:
* Weight < 40 kg: 5 mg dose.
* Weight ≥ 40 kg: 10 mg dose.
* *Frequency:* Maximum of one dose in a 24-hour period. Safety of a second dose in pediatric patients has not been adequately established.
## Dose Adjustments
* **Patients taking Propranolol:** Use 5 mg dose. The maximum daily dose is 15 mg (due to increased rizatriptan plasma concentrations).
* **Renal/Hepatic Impairment:** Use with caution; consider the 5 mg dose for patients with mild to moderate impairment. Not recommended 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 within 2 weeks of MAO inhibitors.
* Concomitant use within 24 hours of other 5-HT1 agonists or ergotamine-type medications.
## Adverse Effects
* **Common:** Dizziness, somnolence, paresthesia, and asthenia/fatigue.
* **Serious:** Coronary vasospasm (chest tightness/pressure), transient myocardial ischemia, arrhythmias, and serotonin syndrome (especially when combined with SSRIs/SNRIs).
## Key Drug Interactions
* **MAO inhibitors:** Contraindicated; risk of significant increase in rizatriptan levels.
* **Propranolol:** Increases rizatriptan AUC by ~70–80%.
* **SSRIs/SNRIs:** Risk of serotonin syndrome; monitor for symptoms (agitation, tachycardia, hyperreflexia).
* **Ergot alkaloids:** Risk of additive vasospastic effects; wait 24 hours between administration.
## Monitoring
* Monitor blood pressure periodically upon initiation.
* Assess for chest, jaw, or neck tightness/pain after the first dose.
* Observe for signs of serotonin syndrome if combined with serotonergic agents.
## Clinical Pearls
* **ODT formulation:** The orally disintegrating tablet must be placed on the tongue and allowed to dissolve; no liquid is required. Do not remove from the blister pack until immediately before use.
* **Efficacy:** Effectiveness is independent of the timing of the dose within the migraine attack, though earlier administration is often clinically preferred for better outcomes.
* **Medication Overuse Headache (MOH):** Limit use to ≤ 10 days per month to prevent rebound headaches.
* **Cardiovascular Safety:** If the patient has cardiovascular risk factors, perform a cardiovascular evaluation before the first dose.
***
**Disclaimer:** This information is for educational purposes and does not replace professional clinical judgment. Verify all dosing and contraindications against institutional protocols and current manufacturer prescribing information (package insert) before prescribing or administering.
