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Rizatriptan

Class
Antimigraine agents
Subclass
Triptans
Substance name
Rizatriptan benzoate
Brand names
Maxalt®
Common formulations
Tablet
Contained in
Meloxicam / rizatriptan (Symbravo®)
Dosage and administration
Adults patients
Symptomatic relief of migraine attacks
•
Maintenance: 5-10 mg PO q2h PRN
•
Maximum: 30 mg per day
Do not exceed rizatriptan use for more than 4 migraine attacks in a 30-day period.
Indications for use
Labeled indications
Adults
•
Symptomatic relief of migraine attacks
Safety risks
Contraindications
Hypersensitivity to rizatriptan or its components
Coronary artery disease
•
Do not use rizatriptan in patients with coronary artery disease, coronary artery vasospasm, including vasospastic angina, or other significant CVDs.
Hemiplegic or basilar migraine
History of stroke or TIA
Ischemic bowel disease
PAD
Uncontrolled hypertension
Concomitant use of MAOIs
•
Do not use rizatriptan with or within 14 days of stopping MAOIs.
Concomitant use of other 5-HT1 agonists or ergots
•
Do not use rizatriptan within 24 hours of taking other 5-HT1 agonists or ergotamine-containing or ergot-type medications, such as dihydroergotamine or methysergide.
Warnings and precautions
Cardiac arrhythmias
•
Maintain a high level of suspicion, as life-threatening cardiac arrhythmias, including VT and VF, have been reported within a few hours following the administration of 5-HT1 agonists.
Cerebrovascular events
•
Maintain a high level of suspicion, as 5-HT1 agonists have been associated with an increased risk of cerebrovascular events, including cerebral hemorrhage, subarachnoid hemorrhage, and stroke.
Chest tightness, chest pain, neck pain, jaw pain
•
Maintain a high level of suspicion, as 5-HT1 agonists have been associated with an increased risk of non-cardiac chest pain and related symptoms.
Hypertension
•
Maintain a high level of suspicion, as 5-HT1 agonists have been associated with an increased risk of significant BP elevations, including hypertensive crisis.
Increased serum rizatriptan levels
•
Use caution in patients taking propranolol. Reduce rizatriptan dose to 5 mg per dose, with a maximal daily dose of 15 mg.
Medication overuse headache
•
Use caution in patients taking the drug for a prolonged period.
Serotonin syndrome
•
Use caution in patients taking SSRIs, SNRIs, or TCAs.
Vasospastic reactions
•
Maintain a high level of suspicion, as 5-HT1 agonists have been associated with an increased risk of non-coronary vasospastic reactions, including peripheral vascular ischemia, gastrointestinal vascular ischemia and infarction, splenic infarction, and Raynaud's syndrome.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Monitor blood pressure.
Renal replacement therapy
Any modality
•
No guidance available.
Hepatic impairment
Any severity
•
No guidance available.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B1
•
Consider safer alternatives. Evidence of fetal harm in animals.
Breastfeeding
Use only if benefits outweigh potential risks.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
Somnolence
Common 1-10%
•
Asthenia, chest pain, diarrhea, dizziness, dry mouth, dyspnea, euphoria, fatigue, headache, hot flashes, hypoesthesia, jaw pain, neck pain, throat pain, nausea, palpitations, tremor, paresthesia, skin flushing, vomiting
Uncommon < 1%
•
Inattention, hearing loss, hallucinations, syncope, incoordination
Unknown frequency
•
Bradycardia, hypertension, raynaud's phenomenon, abdominal discomfort, change in taste, seizure, visual disturbances, myalgia, itching, skin rash, tinnitus, urticaria, hypertensive crisis, tachycardia, toxic epidermal necrolysis, ventricular arrhythmia, myocardial infarction, ischemic colitis, acute mesenteric ischemia, splenic infarction, anaphylaxis, angioedema, medication overuse headache, stroke, transient ischemic attack, serotonin syndrome, wheezing
Interactions
Drug(s)
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