Classes
DEA Class; Rx
Common Brand Names; Maxalt, Maxalt MLT
- Serotonin 5-HT-Receptor Agonists;
- Antimigraine Agents
Description
Oral serotonin agonist
Used for acute migraine in patients >= 6 years old
Causes less sustained coronary artery constriction than ergot alkaloids
Indications
Indicated for the acute treatment of migraine with or without aura.
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
Adverse Effects
- Drowsiness (13-30%, dose related)
- Fatigue (13-30%, dose related)
- Dizziness (11-15%)
- 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%)
Warnings
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)
Pregnancy and Lactation
Available data in pregnant women are not sufficient to draw conclusions about drug-associated risk for major birth defects and miscarriage
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
Maximum Dosage
30 mg/day PO per 24 hour period. If also receiving propranolol, do not exceed 15 mg/day PO. The safety of treating > 4 headaches in a 30-day period is not established.
30 mg/day PO per 24 hour period. If also receiving propranolol, do not exceed 15 mg/day PO. The safety of treating > 4 headaches in a 30-day period is not established.
>= 40 kg: 10 mg PO per 24 hour period. If also receiving propranolol, do not exceed 5 mg/day PO.
< 40 kg: 5 mg PO per 24 hour period.
>= 6 years and >= 40 kg: 10 mg PO per 24 hour period. If also receiving propranolol, do not exceed 5 mg/day PO.
>= 6 years and < 40 kg: 5 mg PO per 24 hour period.
< 6 years: Safety and efficacy have not been established.
How supplied
Rizatriptan
tablet
- 5mg
- 10mg
tablet, oral disintegrating
- 5mg
- 10mg