Rizatriptan oral
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral formulations containing rizatriptan.
Drugs List
Therapeutic Indications
Uses
Acute treatment of migraine attacks with or without aura
Dosage
Adults
The recommended dose is 10mg. If headache returns after relief of initial attack, one further dose only may be taken. The second dose should be separated by at least two hours. Maximum two doses in any 24 hour period.
If there is no response to the first dose, a second dose should not be taken for the same attack.
Patients who do not respond to treatment of an attack may respond to treatment for subsequent attacks.
A lower dose of 5mg should be used by patients on propranolol. Separate dose of rizatriptan from propranolol by 2 hours.
Patients with Renal Impairment
The recommended dose is 5mg. If headache returns after relief of initial attack, one further dose only may be taken. The second dose should be separated by at least two hours. Maximum two doses in any 24 hour period.
Patients with Hepatic Impairment
The recommended dose is 5mg. If headache returns after relief of initial attack, one further dose only may be taken. The second dose should be separated by at least two hours. Maximum two doses in any 24 hour period.
Administration
For oral administration
The absorption of rizatriptan tablets is delayed for approximately one hour when administered together with food.
Contraindications
Children under 18 years
Suspected ischaemic heart disease
Within 2 weeks of discontinuing MAOIs
History of cerebrovascular accident
History of transient ischaemic attack
Ischaemic heart disease
Moderate hypertension
Peripheral vascular disease
Severe hepatic impairment
Severe renal impairment
Uncontrolled hypertension
Precautions and Warnings
Elderly
Predisposition to ischaemic heart disease
Breastfeeding
Galactosaemia
Glucose-galactose malabsorption syndrome
Lactose intolerance
Mild hepatic impairment
Mild renal impairment
Phenylketonuria
Pregnancy
Not for use in atypical headache
Not indicated in hemiplegic, ophthalmoplegic or basilar migraine
Reduce dose in patients with hepatic impairment
Reduce dose in patients with renal impairment
Some formulations contain aspartame - caution in phenylketonuria
Advise ability to drive/operate machinery may be affected by side effects
Some formulations contain lactose
Advise patient to avoid using rizatriptan within 2 hours of propranolol
Avoid ergotamine-type medication for 6 hrs after rizatriptan administration
Avoid rizatriptan for 24hrs after ergotamine-type medication administration
Only for use where a clear diagnosis of migraine has been established
Excessive use may increase frequency of headache, may require withdrawal
Discontinue if angioedema occurs
If angina-like symptoms occur, discontinue treatment and investigate.
Advise patient not to take St John's wort concurrently
Breastfeeding: Do not breastfeed & discard milk for 24 hours after therapy
Discontinue permanently if angioedema occurs. Do not rechallenge with another 5HT 1B/1D agonist.
Evaluate cardiac risk in patients with risk factors for coronary artery disease including hypertension, diabetes, smokers, users of nicotine replacement therapy, men aged over 40 years, postmenopausal women, patients with bundle branch block and patients with a strong family history for coronary artery disease.
Pregnancy and Lactation
Pregnancy
Use rizatriptan with caution during pregnancy.
At the time of writing, there are insufficient data to establish the safety of rizatriptan in pregnancy.
Animal studies do not indicate harmful effects at dose levels that exceed therapeutic dose levels with respect to the development of the embryo or foetus, or the course of gestation, parturition and post-natal development.
The manufacturer recommends only using rizatriptan if clearly necessary.
Lactation
Use rizatriptan with caution during breastfeeding.
There is currently no published experience on the use of rizatriptan with breastfeeding. It is excreted in high levels into the milk of lactating rats, and its molecular weight suggests human excretion is likely. The effect of this exposure on the nursing infant is unknown. LactMed suggests that while use of rizatriptan is not a reason to discontinue breastfeeding, alternative drugs may be preferred, particularly for newborn or premature infants.
If rizatriptan is used during breastfeeding, the manufacturer suggests that milk should be discarded during and for 24 hours after treatment to minimise infant exposure.
Counselling
Rizatriptan oral lyophilisates or orodispersible tablets should be placed on the tongue and allowed to dissolve.
Patients should be instructed not to remove the blister from the outer sachet until just prior to dosing. The blister pack should then be peeled open with dry hands and the oral lyophilisate or orodispersible tablets placed on the tongue.
Migraine or treatment with rizatriptan may cause somnolence in some patients. Dizziness has also been reported in some patients receiving rizatriptan. Patients should, therefore, be advised to evaluate their ability to perform complex tasks during migraine attacks and after administration of rizatriptan.
Patients should be advised not to take concurrent St. John's Wort.
Patient should be advised that rizatriptan should not be taken within two hours of propranolol administration.
Side Effects
Abdominal pain
Anaphylactoid reaction
Anaphylaxis
Angioedema
Arrhythmias
Asthenia
Ataxia
Blurred vision
Bradycardia
Cerebrovascular accident
Chest pain
Diarrhoea
Disorientation
Dizziness
Dry mouth
Dyspepsia
Dyspnoea
ECG changes
Facial oedema
Facial pain
Fatigue
Flushing
Headache
Hot flushes
Hypersensitivity reactions
Hypertension
Hypoesthesia
Impairment of mental skills
Insomnia
Ischaemic colitis
Muscle weakness
Myalgia
Myocardial infarction
Myocardial ischaemia
Nausea
Neck pain
Nervousness
Palpitations
Paraesthesia
Peripheral vascular disorders
Pharyngeal discomfort
Pharyngeal oedema
Pruritus
Rash
Seizures
Sensation of heaviness
Sensation of tightness
Serotonin syndrome
Somnolence
Stiffness
Sweating
Syncope
Tachycardia
Thirst
Tongue swelling
Toxic epidermal necrolysis
Tremor
Unpleasant taste
Urticaria
Vertigo
Vomiting
Wheezing
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: January 2019
Reference Sources
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.
Summary of Product Characteristics: Maxalt 5mg and 10mg tablets. Merck Sharp and Dohme Ltd. Revised July 2018.
Summary of Product Characteristics: Maxalt Melt 10mg Oral Lyophilisates. Merck Sharp and Dohme Ltd. Revised July 2018.
Summary of Product Characteristics: Rizatriptan 5mg Orodispersible tablets. Merck Sharp and Dohme Ltd. Revised October 2017.
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Rizatriptan Last revised: 03 December 2018
Last accessed: 15 January 2019
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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