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

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)
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Patient Handout
Formulary
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