rizatriptan (Rx)

Brand and Other Names:Maxalt, Maxalt MLT
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Dosing & Uses

AdultPediatric

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

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Interactions

Interaction Checker

and rizatriptan

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      Serious - Use Alternative

        Significant - Monitor Closely

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            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 (72)

            • 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.

            • 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.

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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)

            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
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            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.

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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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            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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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Maxalt oral
            -
            10 mg tablet
            Maxalt oral
            -
            10 mg tablet
            Maxalt-MLT oral
            -
            5 mg tablet
            Maxalt-MLT oral
            -
            10 mg tablet
            Maxalt-MLT 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
            -
            10 mg tablet
            rizatriptan oral
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            5 mg tablet
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            Patient Handout

            Patient Education
            rizatriptan oral

            RIZATRIPTAN DISINTEGRATING TABLET - ORAL

            (RYE-za-TRIP-tan)

            COMMON BRAND NAME(S): Maxalt MLT

            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 as directed by your doctor, at the first sign of a migraine. Handle the tablets with dry hands. Place the tablet on your tongue, allow it to dissolve, and swallow with your saliva. You do not need to take this medication with water or other liquid. It may be taken with or without food, but may work faster when it is taken on an empty stomach.Do not break or crush the tablets. If you are using the individually wrapped tablets, do not open the outer pouch until the dose is needed. Peel the foil back and carefully remove the tablet from the blister pack immediately before taking your dose. If you are using the tablets from a bottle, leave the tablets in the bottle they came in until you are ready to take a dose. Keep the bottle tightly closed between uses.The dosage is based on your medical condition, response to treatment, age, and other medications 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 persist or worsen, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she 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).This medication may contain aspartame. If you have phenylketonuria (PKU) or any other condition that requires you to limit/avoid aspartame (or phenylalanine) in your diet, ask your doctor or pharmacist about using this medication safely.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, 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 October 2018. Copyright(c) 2021 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.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.