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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.
## Primary Indications
Acute treatment of migraine attacks with or without aura in adults and pediatric patients (aged 6–17 years). Not indicated for migraine prophylaxis or management of hemiplegic/basilar migraine.
## Adult Dosing
* **Initial Dose:** 5 mg or 10 mg orally.
* **Maximum Dose:** 30 mg in a 24-hour period.
* **Redosing:** If headache recurs or if there is no response to the first dose, a second dose may be administered at least 2 hours after the first dose.
## Pediatric Dosing (Aged 6–17 Years)
* **Patients < 40 kg:** 5 mg dose.
* **Patients ≥ 40 kg:** 10 mg dose.
* **Max Dose:** Only one dose should be administered within a 24-hour period; clinical data on the efficacy of a second dose in pediatric patients is limited.
## Dose Adjustments
* **Patients on Propranolol:** Adult dose should be limited to 5 mg (maximum 15 mg/24 hours).
* **Hepatic/Renal Impairment:** Use with caution in mild-to-moderate impairment; no specific dosing adjustment is established, but lower initial doses are recommended. Not recommended in severe impairment.
## Contraindications
* History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or MI.
* 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-derivative.
* Use within 2 weeks of MAO inhibitor therapy.
## Adverse Effects
* **Common:** Dizziness, somnolence, fatigue, and paresthesia.
* **Serious:** Coronary artery vasospasm, transient myocardial ischemia, arrhythmias, and hypertension.
* **Warning:** Serotonin syndrome risk, especially when co-administered with SSRIs or SNRIs.
## Key Drug Interactions
* **Propranolol:** Increases rizatriptan plasma concentrations significantly.
* **SSRIs/SNRIs:** Increases risk of serotonin syndrome; monitor for agitation, tachycardia, and neuromuscular hyperactivity.
* **Ergot-containing drugs:** Additive risk of vasospasm; maintain a 24-hour separation.
## Monitoring
* Monitor cardiovascular status, particularly in patients with undiagnosed cardiovascular risk factors.
* Assess for medication overuse headache (MOH) if used for > 10 days/month.
## Clinical Pearls
* The orally disintegrating tablet (ODT) does not require water but should be placed on the tongue and allowed to dissolve; do not split ODTs.
* Rizatriptan has a faster onset of action compared to many other triptans due to rapid absorption.
* If a patient fails to respond to a trial of one triptan, it is clinical practice to try a different agent within the class.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice guidelines and local protocols may vary. Always verify current prescribing information, contraindications, and drug interactions via official product labeling (e.g., DailyMed) or institutional pharmacy software before prescribing or administering medication.
