Rizatriptan (Oral Route)

Rizatriptan is a treatment for acute migraine headaches that can be used in children over the age of 6 and in adults.

Overview

Rizatriptan is used in the treatment of acute migraine headaches and their symptoms. It is not, however, suitable for the treatment of cluster headaches.

This treatment is suitable for use in children aged 6+ and in adults who suffer from acute migraine headaches. Dosing will vary depending on weight and other factors.

This treatment is not a normal pain reliever and will not have any impact on other types of pain. Instead, it works in the brain to directly relieve the pain of migraine headaches. This treatment should only be used in patients for whom acetaminophen, aspirin and other pain relievers do not work effectively.

Many patients will experience complete pain relief from a migraine when using this medication. For others this treatment can make the migraine much less painful and in doing so can allow them to return to their usual activities and normal life without completely irradiating the pain experienced. This treatment can also alleviate the symptoms that often accompany migraines including: increased sensitivity to light, increased sensitivity to sound, nausea and vomiting.

This medication is only available with a doctor’s prescription and is administered as Maxalt or Maxalt-MLT. Dose is taken either as a tablet or as a disintegrating tablet.

This medication can cause the patient to become drowsy or dizzy. Patients should ensure that they are fully alert and capable before driving or operating any machinery after taking this medication.

During treatment with this medication you should have regular check ups with your doctor to check for unwanted side effects. Your doctor will also talk to you about the effectiveness of the treatment and assess the frequency of use so that they can determine whether you should continue using the treatment or not.

This medication is a member of the group of medications called triptans. Triptans should never be used in conjunction with one another and triptan medications should only be used for a limited number of uses in any given month. Rizatriptan should not be used for more than 10 days in a month. Use above this level may lead to a worsening of migraines and an increase in their frequency of occurrence.

Condition treated

  • Acute migraine

Type of medicine

  • Triptan

Side Effects

In addition to the needed effects of removing or alleviating the pain and symptoms of an acute migraine, Rizatriptan can also have unwanted side effects in the patient. These unwanted side effects may require that you seek urgent medical attention. In other cases they may naturally abate with use as your body gets used to the treatment.

The following side effects should be reported to a doctor with immediacy:

Occurring commonly:

  • Chest pains
  • Feeling of burning, warmth or tingling of the skin
  • Feeling of tightness or pressure in the chest or neck areas
  • Pounding heart
  • Shortness of breath without exertion

Occurring less commonly:

  • Burning, itching or tingling of the skin
  • Feeling of pressure in the neck, jaw, or throat
  • Increased in heart rate
  • Irregularity of heartbeat
  • Pins and needles
  • Reduced heartbeat

Other side effects may occur that would not usually require the patient to seek medical attention. In some cases, however, these side effects may become bothersome or be ongoing. In these cases you should seek advice when possible from your medical professional. The following side effects would not usually necessitate seeking medical attention:

Occurring commonly:

  • Dizziness
  • Dryness of the mouth
  • Hot flashes
  • Lack of strength
  • Loss of strength
  • Nausea
  • Unusual drowsiness
  • Unusual sleepiness
  • Unusual tiredness
  • Unusual weakness
  • Vomiting

Occurring less commonly:

  • Agitation
  • Anxiousness
  • Blurring of vision
  • Build up of gas
  • Buzzing or ringing heard in the ears
  • Chilliness
  • Cold sensations
  • Confusion or disorientation
  • Constipation
  • Depression or severe sadness
  • Diarrhea
  • Difficulty in swallowing
  • Dryness of the eyes
  • Feeling that self or surroundings are constantly moving or rotating
  • Headaches
  • Heartburn
  • Inability to sleep
  • Increase in frequency and volume of urination
  • Increased sensitivity to heat
  • Increased sweating
  • Increased thirst
  • Irritability or quickness to annoyance
  • Irritation of the eyes
  • Itchiness of the skin
  • Muscle and/or joint stiffness, tightness, or rigidity
  • Muscle pains or spasms
  • Sudden need to urinate
  • Trembling of the hands and/or feet
  • Unusual feeling of well being
  • Warm sensations

Other side effects may occur that have not been listed herein. If you experience other side effects and are concerned about your immediate health then you should contact the emergency services. Report any other side effects to your doctor at your next check up.

Dosage

Rizatriptan should only be taken as prescribed by your doctor. You should never take a larger dose or take this medication more frequently than prescribed and you should not exceed maximum doses in any given timeframe. Doing so will expose you to very serious risks and increase the chance of serious side effects.

This medication should not be used for any pain that is not a migraine headache. If you get a normal headache then you should take a different medication. Discuss this with your doctor before beginning treatment with this medication.

You should prepare to use this treatment as soon as you recognize the signs of a migraine. You should not, however, take it before the pain begins. Wait until the migraine headache pain starts before administering the dose of treatment.

Once you have taken the treatment take a few minutes to lie down in a dark and quiet room whenever possible. This will help to relieve the symptoms and get you back up to fitness.

Discuss with your doctor what you should do if the treatment does not work when you take it. This should be done beforehand so that you know what medications you can take in addition to Rizatriptan to treat the pain. Migraine headaches that are not treated by Rizatriptan may be caused by conditions that require you to take other treatment.

If your headache comes back or worsens after a short period, having initially been relived, adults can take an additional dose of the treatment after 2 hours. Never use more than 2 doses in a 24 hour period, however.

Rizatriptan tablets should be swallowed whole and should not be crushed, dissolved or chewed. Do not take damaged treatments.

If you are prescribed disintegrating tablets then you should keep these in the original packaging until you are ready to use the treatment. Ensure that your hands are dry before touching it and then let it dissolve in your mouth before swallowing.

This medication will always be issued with a patient booklet that you should ensure you have read fully and understand before using this treatment.

The dose of this treatment will be different for each patient depending the condition and the size and age of the patient. You should always follow your doctor’s dosing instructions. The following is a guideline only:

For the treatment of migraine headaches:

  • Adults – 5-10mg. A second dose may be taken after a period of 2 hours if the migraine returns. No more than 2 doses should be taken in a 24 hour period and no more than 30mg in 24 hours as a maximum.
  • Teenagers and children aged over 6 years of age – dose is weight dependant:
  • For those weighing 40kg or more - dose is usually a maximum of 10mg in a 24 hour period.
  • For those weighing less than 40kg – dose is usually a maximum of 5mg in a 24 hour period.
  • Children under the age of 6 – Use and dose must be determined in individual cases by the prescribing doctor.

Interactions

Medications can interact with each other in your body and in some cases the use of medications in conjunction with one another can lead to violent and damaging reactions in the body. In other cases medications can stop each other from working or can expose you to increased risks of suffering side effects. It is important that you inform your doctor of all medications that you are taking before you start using Rizatriptan. This is especially important with the following:

The use of Rizatriptan with the following medications is not recommended. Your doctor may choose not to prescribe Rizatriptan or may change another medication that you are taking:

  • Zolmitriptan
  • Tranylcypromine
  • Sumatriptan
  • Procarbazine
  • Phenelzine
  • Naratriptan
  • Methysergide
  • Methylergonovine
  • Methylene Blue
  • Linezolid
  • Isocarboxazid
  • Frovatriptan
  • Ergotamine
  • Ergonovine
  • Ergoloid Mesylates
  • Eletriptan
  • Dihydroergotamine
  • Bromocriptine
  • Almotriptan

The use of Rizatriptan with the following treatments would not be recommended in normal circumstances. Your doctor may wish to prescribe both in some circumstances, but may wish to make changes to dose or frequency of use:

  • Ziprasidone
  • Zimeldine
  • Vortioxetine
  • Vilazodone
  • Venlafaxine
  • Trazodone
  • Tramadol
  • Tapentadol
  • St John's Wort
  • Sibutramine
  • Sertraline
  • Safinamide
  • Reboxetine
  • Paroxetine
  • Palonosetron
  • Oxycodone
  • Nefazodone
  • Mirtazapine
  • Milnacipran
  • Meperidine
  • Lorcaserin
  • Levomilnacipran
  • Granisetron
  • Fluvoxamine
  • Fluoxetine
  • Fentanyl
  • Femoxetine
  • Escitalopram
  • Duloxetine
  • Dolasetron
  • Desvenlafaxine
  • Clovoxamine
  • Citalopram
  • Buprenorphine
  • Amitriptyline

The use of the following medication alongside Rizatriptan may increase the risk of experiencing certain side effects. Your doctor may still prescribe both for use, but may make changes to dose or frequency of use of the treatments.

  • Propranolol

Other medications that interact with Rizatriptan may exist that have not been listed herein. This list was compiled for likelihood of occurrence and severity and may not be all-inclusive. Ensure that you tell your doctor of all medications that you are taking including herbal remedies, over the counter treatments, prescribed medications and vitamin supplements.

Other medical conditions from which you suffer can also have an impact on the use of this treatment. You should inform your doctor of any other medical conditions from which you suffer as they can prohibit the use of Rizatriptan. This is especially important if you have ever suffered from any of the following:

Do not use Rizatriptan in patients with the following conditions:

  • Angina
  • Basilar migraine
  • History of heart attack
  • Heart problems
  • Blood vessel problems
  • Hemiplegic migraine
  • Hypertension
  • Ischemic bowel disease
  • History of stroke
  • History of transient ischemic attack

Patients with following conditions will be at greater risk of side effects occurring from the use of Rizatriptan:

  • History of coronary artery disease
  • Family history of coronary artery disease
  • Diabetes
  • Hypercholesterolemia
  • Hypertension
  • Obesity
  • Raynaud’s syndrome

Patients with the following condition should not make use of the disintegrating tablet:

  • Phenylketonuria

Other medical conditions not listed herein may also impact the use of this medication. You should inform your doctor of all conditions from which you suffer or from which you have suffered in the past.

Warnings

Before using any medication you should consider the pros and cons of doing so with your doctor. For the use of Rizatriptan you should ensure that you consider all of the side effects listed herein and discuss the following with your doctor where appropriate:

Allergies:

You must inform your doctor of all allergies from which you suffer before beginning treatment. This is particularly important if you have ever reacted badly to any other tirptan medication or to any other medications. Ensure you also share details of any allergies to dyes, preservatives, foods, animals and other substances with your doctor before beginning use of this treatment.

Pediatric:

Safety and efficiency below the age of 6 has not been established. Ensure that this is discussed thoroughly with your doctor if the patient is below 6.

Geriatric:

There are no known limitations connected to use in elderly patients. Patients are, however, more likely to suffer from conditions that may limit the use of this treatment. Consider other medical conditions before beginning use.

Pregnancy:

Inform your doctor if you are pregnant before beginning use. If you are taking this medication and may become pregnant or believe that you have become pregnant then you should discuss this with your doctor. There is a known risk to the use of this treatment in pregnant women.

Breastfeeding:

It is unknown whether this medication can excrete into the milk of the mother or change the composition of the milk. Discuss the risk of breastfeeding with your doctor and weigh them against the benefits of doing so with your doctor.

You should check on the progress of your health or your child’s health with a regular doctor's appointment. This allows you to ensure that the treatment is working effectively and will enable you to determine with your doctor whether use should continue.

This medication should not be used in conjunction with any other triptan or ergot-type treatments and at least 24 hours should be left between the use of these medications and Rizatriptan.

If this medication does not cause your migraine to go away, if it makes them worse, or if they become more regular then you should arrange an urgent appointment with your doctor.

This medication will increase your risk of suffering from some serious medical conditions. Your risk of this will be increased if you have a hereditary inclination to these conditions, if you have high blood pressure, diabetes, high cholesterol or if you smoke. Males over 40 and women who have passed through menopause are also at greater risk from these conditions. The conditions of significant increased risk are:

  • Abnormality of heart rhythm
  • Angina
  • Heart attack
  • Stroke

If you experience any of the symptoms of these conditions then you must seek emergency medical attention right away. These symptoms include:

  • Chest pains
  • Confusion or disorientation
  • Difficulty in speaking
  • Headaches
  • Inability to speak
  • Inability to utilize muscles
  • Nausea
  • Seeing double
  • Shortness of breath
  • Slow speech
  • Slurring of speech
  • Sweating when cool
  • Uneven heartbeat
  • Vomiting

You may need to visit a ophthalmologist when using this treatment. This is particularly important if you experience any changes in vision during use.

You should not use this treatment any more than 10 days in a month. Doing so will likely lead to a worsening of your condition. Patients should keep a diary of use with details of dates, times and dose taken to ensure that use is not exceeding this level.

The consumption of alcohol can make headaches worse or can trigger headaches. You should avoid the consumption of alcohol to reduce risk and should avoid alcohol completely when you are suffering a headache.

You should inform your doctor of all medications you are taking before use and you should check before using any other treatments too. Failure to do so can expose you to serious complications. In some cases use with other medications can cause serotonin syndrome, which is a very serious medical condition. Contact a doctor immediately if you or your child experience any of the following symptoms of serotonin syndrome:

  • Agitation
  • Fever
  • Shaking
  • Sweating
  • Trembling
  • Twitching

This medication can make you dizzy or drowsy. Ensure that you are fit and competent to do so before driving or operating machinery after taking this treatment. Remember that it is your legal responsibility to ensure that you and those around you are safe when in control of a vehicle.

Storage

This medication should be stored in a sealed container out of the reach of children at all times.

Dissolving tablets should be kept in the original packaging until the time of use.

Keep medication out of direct light and away from moisture and heat at all time.

Dispose of any unwanted medication appropriately and safely, ensuring they are out of reach of children at all times.

Summary

Rizatriptan is a treatment of acute migraines. It works in the brain to alleviate the pain and other symptoms caused by this condition.

Rizatriptan is not a normal pain reliever, however, and will not be effective against any other forms of pain, including that caused by cluster headaches. Alternative treatments must be found for these conditions.

This treatment is available by prescription only and is available as either a tablet or a dissolving tablet. The dose should be taken only when the pain symptoms of the migraine begin and not before. The medication is available as Maxalt or Maxalt-MLT.

In some cases the patient will be totally relieved from the pain of the migraine after the dose. In other cases, however, the pain will merely be relieved. The treatment should allow the patient to return to normal operation and be able to carry on with their day. Usually the other symptoms of nausea and blurred vision will also be alleviated once the pain symptoms have abated.

In adults, if the migraine returns over time then a second dose of the medication can be taken as long as there has been a 2 hour gap between doses. The patient should never take more than 2 doses in a 24 hour period, however.

This treatment should not be taken in conjunction with a wide range of other treatments. You should inform your doctor of all other medications that you take before beginning treatment with this medication and you should never take any other triptan medications at the same time as using this treatment.

The use of this medication more than 10 times in a 1 month period will result in the worsening of migraines and an increase in their frequency. You should never exceed this volume and you should keep a medication diary to keep track of how much of this medication you are taking and how frequently it is occurring.

When using this treatment you should have a regular check up with your doctor to determine whether you should continue its use.

Resources
Last Reviewed:
January 30, 2018
Last Updated:
February 10, 2018