Rizatriptan

Rizatriptan is a prescription medicine used to treat the symptoms of migraine headaches.

• Rizatriptan is available under the following different brand names: Maxalt, Maxalt MLT

Adult and pediatric dosage

Tablet

• 5mg
• 10mg

Tablet, oral disintegrating

• 5mg
• 10mg

Migraine Headache

Adult dosage

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

Pediatric dosage

• Children below 6 years: Safety and efficacy not established
• Children between 6-17 years (less than 40 kg): 5 mg orally once every 24 hours
• Children between 6-17 years (40 kg or greater):10 mg orally once every 24 hours
• Efficacy and safety of treatment with more than 1 dose within 24 hours in pediatric patients have not been established

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of Rizatriptan include:

• dizziness,
• drowsiness,
• feeling tired, and
• pain or feeling of pressure in the throat or chest.

Serious side effects of Rizatriptan include:

• sudden and severe stomach pain,
• bloody diarrhea,
• cold feeling,
• numbness in the feet and hands,
• severe headache,
• blurred vision,
• pounding in the neck or ears,
• chest pain or pressure,
• pain spreading to jaw or shoulder,
• nausea,
• sweating,
• agitation,
• hallucinations,
• fever,
• shivering,
• fast heart rate,
• muscle stiffness,
• twitching,
• loss of coordination,
• vomiting,
• sudden numbness or weakness (especially on one side of the body),
• slurred speech, and
• problems with vision or balance.

Rare side effects of Rizatriptan include:

• none 

This is not a complete list of side effects and other serious side effects or health problems that may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

Rizatriptan has severe interactions with the following drugs:

• almotriptan
• cabergoline
• dihydroergotamine
• dihydroergotamine intranasal
• eletriptan
• ergoloid mesylates
• ergotamine
• frovatriptan
• methylergonovine
• naratriptan
• procarbazine
• sumatriptan
• sumatriptan intranasal
• zolmitriptan

Rizatriptan has serious interactions with the following drugs:

• citalopram
• cyclobenzaprine
• desvenlafaxine
• dolasetron
• granisetron
• isocarboxazid
• linezolid
• lorcaserin
• methylene blue
• netupitant/palonosetron
• ondansetron
• ozanimod
• palonosetron
• phenelzine
• procarbazine
• rasagiline
• tedizolid
• tranylcypromine
• vilazodone
• vortioxetine

Rizatriptan has moderate interactions with at least 72 other drugs.

Rizatriptan has minor interactions with the following drugs:

• duloxetine
• escitalopram
• fluoxetine
• milnacipran
• nefazodone
• paroxetine
• sertraline
• trazodone
• venlafaxine

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• Hypersensitivity
• Ischemic heart disease, uncontrolled hypertension, or another 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

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Rizatriptan?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Rizatriptan?”

Cautions

• Use caution in hepatic/renal insufficiency
• Overuse of acute migraine drugs (eg, ergotamine, triptans, opioids, or a combination of these drugs for more than10 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 were reported with the use of 5-HT1 agonists
• Significant hypertension or hypertensive crisis reported in patients with and without a 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 were reported with 5-HT1 agonist
• Transient or permanent partial vision loss and blindness were 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 above 40 years of age or is a smoker unless the patient undergoes adequate cardiac evaluation; patients suspected of having CAD should have CAD ruled out before considering the use of the drug; if evaluation satisfactory, the 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 a coadministered adjustment is needed (see Dosage Modifications)
  • Ergot-containing drugs may cause prolonged vasospastic reactions; because these effects may be additive if coadministered, the use of ergotamine-containing medications and rizatriptan is contraindicated within 24 hours
  • Similarly, the use of other 5-HT1 agonists within 24 hours of rizatriptan is contraindicated owing to additive vasospasm reactions

Pregnancy and Lactation

• Available data in pregnant women are not sufficient to conclude the 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 throughout 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 a 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
• 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, on the effects of rizatriptan on the breastfed infant, or milk production
  • Rizatriptan was excreted in rat milk, with levels in milk ~6 times those in maternal plasma