rizatriptan (Rx)Brand and Other Names:Maxalt, Maxalt MLT

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 5mg
  • 10mg

tablet, oral disintegrating

  • 5mg
  • 10mg
more...

Migraine Headache

Acute treatment of migraine with or without aura

5-10 mg PO at onset of symptoms; repeat dose after 2 hours if necessary; not to exceed 30 mg/24 hr

Dosing considerations

  • Patients taking propranolol: Limit dose to 5 mg PO and do not exceed 15 mg/24 hr

Dosage Forms & Strengths

tablet

  • 5mg
  • 10mg

tablet, oral disintegrating

  • 5mg
  • 10mg
more...

Migraine Headache

Acute treatment of migraine with or without aura

<6 years: Safety and efficacy not established

6-17 years (<40 kg): 5 mg PO once q24hr

6-17 years: (40 kg or greater): 10 mg PO once q24hr

Dosing considerations

  • Efficacy and safety of treatment with more than 1 dose within 24 hours in pediatric patients has not been established
  • 6-17 years (<40 kg) taking propranolol: Do not administer rizatriptan
  • 6-17 years (≥40 kg) taking propranolol: Limit dose to 5 mg PO once q24hr as necessary; not to exceed 5 mg/24hr
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Interactions

Interaction Checker

rizatriptan and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Drowsiness (13-30%, dose related)

            Fatigue (13-30%, dose related)

            Dizziness (11-15%)

            1-10%

            Dizziness (4-9%)

            Somnolence (4-8%)

            Fatigue (4-7%; dose related)

            Nausea (4-6%)

            Asthenia (1-5%)

            Hot flashes (1-5%)

            Paresthesia (3-4%)

            Dry mouth (3%)

            Chest pain (2-3%)

            Pain/pressure in chest, neck, throat, jaw (<2%)

            Headache (<2%)

            Dyspnea (>1%)

            Hypoesthesia (>1%)

            Palpations (>1%)

            Skin flushing (>1%)

            <1%

            Tachycardia

            Angioedema

            Wheezing

            Hypertensive crisis

            Bradycardia

            Hallucination

            Epidermal necrolysis

            Hearing impairment

            Arrhythmias

            Myocardial infarction and coronary artery vasospasm in patients with CAD risk factors

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            Warnings

            Contraindications

            Hypersensitivity

            Ischemic heart disease, uncontrolled hypertension, or other significant cardiovascular disease

            Coronary artery vasospasm

            History of stroke or transient ischemic attack

            Ischemic bowel

            Peripheral vascular disease

            Basilar or hemiplegic migraine

            Within 24 hours of another 5-HT1 agonist or ergot derivative

            Within 2 weeks of MAOI

            Cautions

            Use caution in hepatic/renal insufficiency

            Overuse of acute migraine drugs (eg, ergotamine, triptans, opioids, or combination of these drugs for ≥10 days/month) may lead to exacerbation of headache (medication overuse headache)

            Potentially life-threatening serotonin syndrome may occur, particularly during combined use with SSRIs (eg, fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, escitalopram) or SNRIs (eg, venlafaxine, duloxetine)

            Coronary artery vasospasm, ventricular tachycardia/fibrillation, cardiac arrest, myocardial infarction, transient ischemia, and death reported with the use of 5-HT1 agonists

            Cerebral/subarachnoid hemorrhage and stroke reported with the use of 5-HT1 agonists

            Significant hypertension or hypertensive crisis reported in patients with and without history of hypertension

            Not for use in the prevention of migraine or the treatment of cluster headaches

            Maxalt-MLT tablets contain phenylalanine (not for use in patients with phenylketonuria)

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Unknown; use with caution in breastfeeding

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Selective 5-HT1 receptor agonist in cranial arteries; causes vasoconstriction and reduces inflammation associated with antidromic neuronal transmission linked to relief of migraine

            Absorption

            Bioavailability: 45-50%

            Onset of action: Within 2 hr

            Peak plasma time: 1-1.5 hr

            AUC: 30% higher in females than in males

            Distribution

            Protein bound: 14%

            Vd: 110 L (female); 140 L (male)

            Metabolism

            Metabolized by MAO-O

            Metabolites: N-monodesmethyl-rizatriptan

            Elimination

            Half-life elimination: 2-3 hr

            Excretion: Urine (82%); feces (12%)

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            Images

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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