Dosing & Uses
Dosage Forms & Strengths
tablet
- 5mg
- 10mg
tablet, oral disintegrating
- 5mg
- 10mg
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
Dosage Modifications
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
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
Efficacy and safety of treatment with more than 1 dose within 24 hours in pediatric patients has not been established
Dosage Modifications
6-17 years (<40 kg) taking propranolol: Do not prescribe rizatriptan
6-17 years (≥40 kg) taking propranolol: Limit dose to 5 mg PO once q24hr; not to exceed 5 mg/24hr
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (14)
- almotriptan
almotriptan, rizatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- cabergoline
cabergoline, rizatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- dihydroergotamine
dihydroergotamine, rizatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- dihydroergotamine intranasal
dihydroergotamine intranasal, rizatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- eletriptan
eletriptan, rizatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- ergoloid mesylates
ergoloid mesylates, rizatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- ergotamine
ergotamine, rizatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- frovatriptan
frovatriptan, rizatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- methylergonovine
methylergonovine, rizatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- naratriptan
naratriptan, rizatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- procarbazine
rizatriptan and procarbazine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.
- sumatriptan
rizatriptan, sumatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- sumatriptan intranasal
rizatriptan, sumatriptan intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- zolmitriptan
rizatriptan, zolmitriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
Serious - Use Alternative (20)
- citalopram
citalopram, rizatriptan. Mechanism: unknown. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome. If concomitant treatment with citalopram and a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.
- cyclobenzaprine
rizatriptan and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.
- desvenlafaxine
rizatriptan and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.
- dolasetron
dolasetron, rizatriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- granisetron
granisetron, rizatriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- isocarboxazid
rizatriptan and isocarboxazid both increase serotonin levels. Avoid or Use Alternate Drug.
isocarboxazid increases levels of rizatriptan by decreasing metabolism. Contraindicated. - linezolid
rizatriptan and linezolid both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.
linezolid increases levels of rizatriptan by decreasing metabolism. Contraindicated. - lorcaserin
rizatriptan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.
- methylene blue
rizatriptan and methylene blue both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.
- netupitant/palonosetron
netupitant/palonosetron, rizatriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- ondansetron
ondansetron, rizatriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- ozanimod
ozanimod increases toxicity of rizatriptan by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
- palonosetron
palonosetron, rizatriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- phenelzine
rizatriptan and phenelzine both increase serotonin levels. Avoid or Use Alternate Drug.
phenelzine increases levels of rizatriptan by decreasing metabolism. Contraindicated. - procarbazine
procarbazine increases levels of rizatriptan by serotonin levels. Avoid or Use Alternate Drug.
- rasagiline
rizatriptan and rasagiline both increase serotonin levels. Avoid or Use Alternate Drug. Avoid combination within 14 days of MAOI use
- tedizolid
tedizolid, rizatriptan. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.
- tranylcypromine
rizatriptan and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug. Concomitant use or use within 2 wks following the discontinuation of tranylcypromine is contraindicated.
tranylcypromine increases levels of rizatriptan by decreasing metabolism. Contraindicated. - vilazodone
rizatriptan, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .
- vortioxetine
rizatriptan, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.
Monitor Closely (73)
- 5-HTP
rizatriptan and 5-HTP both increase serotonin levels. Use Caution/Monitor.
- almotriptan
almotriptan and rizatriptan both increase serotonin levels. Use Caution/Monitor.
- amitriptyline
rizatriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- amoxapine
rizatriptan and amoxapine both increase serotonin levels. Modify Therapy/Monitor Closely.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, rizatriptan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- buspirone
rizatriptan and buspirone both increase serotonin levels. Modify Therapy/Monitor Closely.
- clomipramine
rizatriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- cocaine
rizatriptan and cocaine both increase serotonin levels. Use Caution/Monitor.
- cyproheptadine
cyproheptadine decreases effects of rizatriptan by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of serotonin agonists.
- desipramine
rizatriptan and desipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- dexfenfluramine
rizatriptan and dexfenfluramine both increase serotonin levels. Use Caution/Monitor.
- dextroamphetamine
rizatriptan and dextroamphetamine both increase serotonin levels. Use Caution/Monitor.
- dextroamphetamine transdermal
rizatriptan, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).
- dextromethorphan
rizatriptan and dextromethorphan both increase serotonin levels. Modify Therapy/Monitor Closely.
- dihydroergotamine
rizatriptan and dihydroergotamine both increase serotonin levels. Use Caution/Monitor.
- dihydroergotamine intranasal
rizatriptan and dihydroergotamine intranasal both increase serotonin levels. Use Caution/Monitor.
- dosulepin
rizatriptan and dosulepin both increase serotonin levels. Modify Therapy/Monitor Closely.
- doxepin
rizatriptan and doxepin both increase serotonin levels. Modify Therapy/Monitor Closely.
- droxidopa
rizatriptan and droxidopa both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. May increase risk for supine hypertension
- duloxetine
rizatriptan and duloxetine both increase serotonin levels. Modify Therapy/Monitor Closely.
- eletriptan
eletriptan and rizatriptan both increase serotonin levels. Use Caution/Monitor.
- ergotamine
rizatriptan and ergotamine both increase serotonin levels. Use Caution/Monitor.
- escitalopram
rizatriptan and escitalopram both increase serotonin levels. Modify Therapy/Monitor Closely.
- fenfluramine
rizatriptan and fenfluramine both increase serotonin levels. Use Caution/Monitor.
fenfluramine, rizatriptan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome. - fluoxetine
rizatriptan and fluoxetine both increase serotonin levels. Modify Therapy/Monitor Closely.
- fluphenazine
rizatriptan, fluphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- fluvoxamine
fluvoxamine and rizatriptan both increase serotonin levels. Modify Therapy/Monitor Closely.
- frovatriptan
frovatriptan and rizatriptan both increase serotonin levels. Use Caution/Monitor.
- haloperidol
rizatriptan, haloperidol. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- hydrocodone
hydrocodone, rizatriptan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- imipramine
rizatriptan and imipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- isoniazid
rizatriptan and isoniazid both increase serotonin levels. Use Caution/Monitor.
- L-tryptophan
rizatriptan and L-tryptophan both increase serotonin levels. Use Caution/Monitor.
- levomilnacipran
rizatriptan and levomilnacipran both increase serotonin levels. Modify Therapy/Monitor Closely.
- lisdexamfetamine
rizatriptan and lisdexamfetamine both increase serotonin levels. Use Caution/Monitor.
- lithium
rizatriptan and lithium both increase serotonin levels. Use Caution/Monitor.
- lofepramine
rizatriptan and lofepramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- loxapine
rizatriptan, loxapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- loxapine inhaled
rizatriptan, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- lsd
rizatriptan and lsd both increase serotonin levels. Use Caution/Monitor.
- maprotiline
rizatriptan and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.
- meperidine
rizatriptan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.
- milnacipran
rizatriptan and milnacipran both increase serotonin levels. Modify Therapy/Monitor Closely.
- mirtazapine
rizatriptan and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- molindone
rizatriptan, molindone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- morphine
rizatriptan and morphine both increase serotonin levels. Use Caution/Monitor.
- naratriptan
naratriptan and rizatriptan both increase serotonin levels. Use Caution/Monitor.
- nefazodone
rizatriptan and nefazodone both increase serotonin levels. Modify Therapy/Monitor Closely.
- nortriptyline
rizatriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- oliceridine
rizatriptan, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.
- paroxetine
rizatriptan and paroxetine both increase serotonin levels. Modify Therapy/Monitor Closely.
- pentazocine
rizatriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.
- perphenazine
rizatriptan, perphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- pimozide
rizatriptan, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- propranolol
propranolol increases levels of rizatriptan by unknown mechanism. Use Caution/Monitor. Do not exceed rizatriptan 5 mg/dose, up to a maximum of 3 doses in 24 hr .
- protriptyline
rizatriptan and protriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- remifentanil
remifentanil increases toxicity of rizatriptan by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.
- SAMe
rizatriptan and SAMe both increase serotonin levels. Use Caution/Monitor.
- selegiline
rizatriptan and selegiline both increase serotonin levels. Modify Therapy/Monitor Closely.
- selegiline transdermal
rizatriptan and selegiline transdermal both increase serotonin levels. Modify Therapy/Monitor Closely.
- sertraline
rizatriptan and sertraline both increase serotonin levels. Modify Therapy/Monitor Closely.
- St John's Wort
rizatriptan and St John's Wort both increase serotonin levels. Modify Therapy/Monitor Closely.
- sufentanil SL
sufentanil SL, rizatriptan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- sumatriptan
rizatriptan and sumatriptan both increase serotonin levels. Use Caution/Monitor.
- sumatriptan intranasal
rizatriptan and sumatriptan intranasal both increase serotonin levels. Use Caution/Monitor.
- tapentadol
rizatriptan and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.
- thiothixene
rizatriptan, thiothixene. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- tramadol
rizatriptan and tramadol both increase serotonin levels. Use Caution/Monitor.
- trazodone
rizatriptan and trazodone both increase serotonin levels. Modify Therapy/Monitor Closely.
- trifluoperazine
rizatriptan, trifluoperazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- trimipramine
rizatriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- venlafaxine
rizatriptan and venlafaxine both increase serotonin levels. Modify Therapy/Monitor Closely.
- zolmitriptan
rizatriptan and zolmitriptan both increase serotonin levels. Use Caution/Monitor.
Minor (9)
- duloxetine
duloxetine, rizatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- escitalopram
escitalopram, rizatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- fluoxetine
fluoxetine, rizatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- milnacipran
milnacipran, rizatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- nefazodone
nefazodone, rizatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- paroxetine
paroxetine, rizatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- sertraline
sertraline, rizatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- trazodone
trazodone, rizatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- venlafaxine
venlafaxine, rizatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
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
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)
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)
Patients with sensations of chest pain/pressure/tightness or symptoms suggestive of angina following dosing should be evaluated for coronary artery disease or Prinzmetal’s angina before administering additional doses; monitor with ECG if dosing is resumed and similar symptoms occur
Peripheral vascular ischemia and colonic ischemia, gastrointestinal ischemia/infarction, splenic infarction, and Raynaud’s syndrome reported with 5-HT1 agonist
Transient or permanent partial vision loss and blindness reported (rare)
Not for administration to patients who have risk factors for coronary artery disease (CAD), including hypertension, obesity, hypercholesterolemia, diabetes, menopause, strong family history of CAD, male >40 years of age or is a smoker unless patient undergoes adequate cardiac evaluation; patients suspected of having CAD, should have CAD ruled out before considering use of drug; if evaluation satisfactory, first dose should be administered in the healthcare provider’s office; perform periodic evaluation of cardiovascular status in all patients
Drug interaction overview
- Potentially life-threatening serotonin syndrome may occur, particularly during combined use with SSRIs, SNRIs, TCAs, or MAOIs
- Rizatriptan use is contraindicated with concurrent administration of or recent discontinuation (ie, within 2 weeks) of MAOIs
- Propranolol increases rizatriptan AUC by 70%; decrease rizatriptan dose if coadministered adjustment needed (see Dosage Modifications)
- Ergot-containing drugs may cause prolonged vasospastic reactions; because these effects may be additive if coadministered, use of ergotamine-containing medications and rizatriptan are contraindicated within 24 hr
- Similarly, use of other 5-HT1 agonists within 24 hr of rizatriptan is contraindicated owning to additive vasospasm reactions
Pregnancy & Lactation
Pregnancy
Available data in pregnant women are not sufficient to draw conclusions about drug-associated risk for major birth defects and miscarriage
The Pregnancy Registry for rizatriptan did not identify any pattern of congenital anomalies or other adverse birth outcomes over the period of 1998-2018; however, the lack of identification of any pattern should be viewed with caution, as the number of prospective reports with outcome information was low and did not provide sufficient power to detect an increased risk of individual birth defects associated with the use
Additionally, there was significant loss to follow-up in the prospective pregnancy reports, further complicating this assessment of an association between rizatriptan and any pattern of congenital anomalies or other adverse birth outcomes
Animal data
- Developmental toxicity was observed following oral administration of rizatriptan during pregnancy (decreased fetal body weight in rats) or throughout pregnancy and lactation (increased mortality, decreased body weight, and neurobehavioral impairment in rat offspring) at maternal plasma exposures greater than that expected at therapeutic doses in humans
Clinical considerations
- In women with migraine, there is an increased risk of adverse perinatal outcomes in the mother, including pre-eclampsia and gestational hypertension
Lactation
Data are not available on the presence of rizatriptan or any active metabolites in human milk, or on the effects of rizatriptan on the breastfed infant, or on milk production
Rizatriptan was excreted in rat milk, with levels in milk ~6 times those in maternal plasma
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.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%)
Administration
Oral Administration
May take with or without food
Oral disintegrating tablet (ODT)
- Administration with liquid is not necessary
- ODTs are packaged in a blister within an outer aluminum pouch; do not remove the blister from the outer pouch until just before dosing
- Peel open blister pack with dry hands and place ODT on the tongue, where it will dissolve and be swallowed with the saliva
Storage
Tablets or ODT: Store at room temperature 15-30ºC (59-86ºF)
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Maxalt oral - | 10 mg tablet |  | |
| Maxalt oral - | 10 mg tablet |  | |
| Maxalt-MLT oral - | 10 mg tablet |  | |
| Maxalt-MLT oral - | 5 mg tablet |  | |
| Maxalt-MLT oral - | 5 mg tablet |  | |
| rizatriptan oral - | 10 mg tablet |  | |
| rizatriptan oral - | 10 mg tablet |  | |
| rizatriptan oral - | 10 mg tablet |  | |
| rizatriptan oral - | 5 mg tablet |  | |
| rizatriptan oral - | 10 mg tablet |  | |
| rizatriptan oral - | 5 mg tablet |  | |
| rizatriptan oral - | 10 mg tablet |  | |
| rizatriptan oral - | 5 mg tablet |  | |
| rizatriptan oral - | 5 mg tablet |  | |
| rizatriptan oral - | 5 mg tablet |  | |
| rizatriptan oral - | 5 mg tablet |  | |
| rizatriptan oral - | 10 mg tablet |  | |
| rizatriptan oral - | 5 mg tablet |  | |
| rizatriptan oral - | 10 mg tablet |  | |
| rizatriptan oral - | 5 mg tablet |  | |
| rizatriptan oral - | 10 mg tablet |  | |
| rizatriptan oral - | 10 mg tablet |  | |
| rizatriptan oral - | 5 mg tablet |  | |
| rizatriptan oral - | 10 mg tablet |  | |
| rizatriptan oral - | 10 mg tablet |  | |
| rizatriptan oral - | 5 mg tablet |  | |
| rizatriptan oral - | 5 mg tablet |  | |
| rizatriptan oral - | 5 mg tablet |  | |
| rizatriptan oral - | 10 mg tablet |  | |
| rizatriptan oral - | 10 mg tablet |  | |
| rizatriptan oral - | 5 mg tablet |  | |
| rizatriptan oral - | 5 mg tablet |  | |
| rizatriptan oral - | 10 mg tablet |  | |
| rizatriptan oral - | 5 mg tablet |  | |
| rizatriptan oral - | 10 mg tablet |  |
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Patient Handout
rizatriptan oral
RIZATRIPTAN TABLET - ORAL
(RYE-za-TRIP-tan)
COMMON BRAND NAME(S): Maxalt
USES: Rizatriptan is used to treat migraines. It helps to relieve headache, pain, and other migraine symptoms (including nausea, vomiting, sensitivity to light/sound). Prompt treatment helps you return to your normal routine and may decrease your need for other pain medications. Rizatriptan belongs to a class of drugs known as triptans. It affects a certain natural substance (serotonin) that causes narrowing of blood vessels in the brain. It may also relieve pain by affecting certain nerves in the brain.Rizatriptan does not prevent future migraines or lessen how often you get migraine attacks.
HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start taking rizatriptan and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth as directed by your doctor, at the first sign of a migraine. It may be taken with or without food, but may work faster when it is taken on an empty stomach. The dosage is based on your medical condition, age, response to treatment, and other drugs you may be taking. For children, the dosage is also based on weight. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).If there is no improvement in your symptoms, do not take more doses of this medication before talking to your doctor. If your symptoms are only partly relieved, or if your headache comes back, adults may take another dose at least 2 hours after the first dose. Children should not take more than one dose, or 5 milligrams in a 24-hour period. For adults, the US manufacturer recommends a maximum dose of 30 milligrams in a 24-hour period. The Canadian manufacturer recommends a maximum dose of 20 milligrams (for adults) in a 24-hour period.If you have a higher risk for heart problems (see Precautions), your doctor may perform a heart exam before you start taking rizatriptan. He/she may also direct you to take your first dose of this medication in the office/clinic to monitor for serious side effects (such as chest pain). Talk to your doctor for details.If you are using drugs for migraine attacks on 10 or more days each month, the drugs may actually make your headaches worse (medication overuse headache). Do not use medications more often or for longer than directed. Tell your doctor if you need to use this medication more often, or if the medication is not working as well, or if your headaches get worse.
SIDE EFFECTS: Flushing, feelings of tingling/numbness/prickling/heat, tiredness, weakness, drowsiness, or dizziness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.Tell your doctor right away if you have any serious side effects, including: blue fingers/toes/nails, cold hands/feet, hearing changes, mental/mood changes.Rizatriptan can commonly cause chest/jaw/neck tightness, pain, or pressure that is usually not serious. However, these side effects are like symptoms of a heart attack, which may include chest/jaw/left arm pain, shortness of breath, or unusual sweating. Get medical help right away if these or other serious side effects occur, including: fast/irregular heartbeat, fainting, severe stomach/abdominal pain, bloody diarrhea, signs of a stroke (such as weakness on one side of the body, trouble speaking, sudden vision changes, confusion).This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using rizatriptan, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood circulation problems (for example, in your legs, arms/hands, or stomach), certain types of headaches (hemiplegic or basilar migraine), heart problems (such as chest pain, irregular heartbeat, previous heart attack), liver disease, seizure, stroke or "mini-stroke" (transient ischemic attack).Certain conditions can increase your risk for heart problems. Tell your doctor if you have any of these conditions, including: high blood pressure, high cholesterol, diabetes, family history of heart disease, overweight, smoker, postmenopausal (women), age more than 40 years (men).This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).The risk of heart disease, liver disease, and high blood pressure increases with age. Older adults may be more sensitive to the side effects of this drug, especially increased blood pressure and heart problems.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Do not take any MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.If you also take any ergotamine medication (such as dihydroergotamine) or other "triptan" drugs (such as sumatriptan, zolmitriptan), you will need to separate your rizatriptan dose at least 24 hours apart from your dose of these other medications to lessen the chance of serious side effects.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: Do not share this medication with others.Certain foods, beverages, or food additives (such as red wine, cheese, chocolate, monosodium glutamate) as well as lifestyle patterns such as irregular eating/sleeping habits or stress may bring on a migraine headache. Avoiding these "triggers" may help lessen migraine attacks. Consult your doctor for more details.Laboratory and/or medical tests (such as blood pressure) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.
MISSED DOSE: Not applicable. (See How to Use section.)
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised March 2022. Copyright(c) 2022 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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