Class
- Triptan
Rizatriptan
Commonly Prescribed for
(FDA approved in bold)
- Migraine
Rizatriptan
How the Drug Works
- Selective 5-HT1 receptor agonist, working predominantly at the B and D receptor subtypes. Effectiveness may be due to blocking the transmission of pain signals from the trigeminal nerve to the trigeminal nucleus caudalis and preventing release of inflammatory neuropeptides rather than just causing vasoconstriction
Rizatriptan
How Long Until It Works
- 1 hour or less
Rizatriptan
If It Works
- Continue to take as needed. Patients taking acute treatment more than 2 days/week are at risk for medication-overuse headache, especially if they have migraine
Rizatriptan
If It Doesn’t Work
- Treat early in the attack – triptans are less likely to work after the development of cutaneous allodynia, a marker of central sensitization
- For patients with partial response or reoccurrence, add an NSAID
- Change to another agent
Rizatriptan
Best Augmenting Combos for Partial Response or Treatment-Resistance
- NSAIDs or neuroleptics are often used to augment response
Rizatriptan
Tests
- None required
Adverse Effects (AEs)
Rizatriptan
How Drug Causes AEs
- Direct effect on serotonin receptors
Rizatriptan
Notable AEs
- Tingling, flushing, sensation of burning, dizziness, sensation of pressure, palpitations, heaviness, nausea
Rizatriptan
Life-Threatening or Dangerous AEs
- Rare cardiac events including acute MI, cardiac arrhythmias, and coronary artery vasospasm have been reported with rizatriptan
Rizatriptan
Weight Gain
- Unusual
Rizatriptan
Sedation
- Unusual
Rizatriptan
What to Do About AEs
- In most cases, only reassurance is needed. Lower dose, change to another triptan or use an alternative headache treatment
Rizatriptan
Best Augmenting Agents for AEs
- Treatment of nausea with antiemetics is acceptable. Other AEs improve with time
Dosing and Use
Rizatriptan
Usual Dosage Range
- 5–10 mg, maximum 20 mg/day
