How does this medication work? What will it do for me?
Rizatriptan belongs to a class of medications known as 5-hydroxytryptamine agonists (also called triptans). It is used to treat migraine headaches with or without aura (warning signs that occur prior to the onset of a migraine headache). The pain of migraine headaches is thought to be caused by dilated blood vessels inside the head. Rizatriptan relieves migraine headaches by constricting these blood vessels.
Rizatriptan is most effective if taken at the first sign of a migraine headache. It is not recommended for other types of headache or for headache prevention. Relief from the pain associated with migraine may occur as quickly as within 30 minutes, with maximum pain relief occurring about 2 hours after taking the medication.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
Each pale pink, capsule-shaped compressed tablet, embossed with the code “MSD 267” on one side and “MAXALT” on the other, contains rizatriptan 10 mg (corresponding to 14.53 mg of the benzoate salt). Nonmedicinal ingredients: ferric oxide (red), lactose monohydrate, magnesium stearate, microcrystalline cellulose, and pregelatinized starch.
How should I use this medication?
The recommended adult starting dose of rizatriptan is 5 mg. In some cases, a starting dose of 10 mg may be used. The dose should be taken at the first sign of migraine headache pain. If the migraine headache comes back after being relieved, another dose (5 mg to 10 mg) may be taken no sooner than 2 hours after the first dose was taken.
The maximum recommended single dose is 10 mg. No more than 20 mg of rizatriptan should be taken in any 24-hour period. If your headache pain is different from your usual migraines, do not take rizatriptan and call your doctor. Rizatriptan is not to be used for headache prevention.
It is important to take this medication exactly as prescribed by your doctor.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
Store this medication at room temperature, protect it from moisture, and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not take this medication if you:
- are allergic to rizatriptan or any ingredients of this medication
- do not have a clear diagnosis of migraine
- have angina (chest pain), including Prinzmetal’s angina (coronary vasospasm)
- have blood vessel disease (e.g., ischemic bowel disease, Raynaud’s syndrome)
- have certain types of migraine headaches (including hemiplegic, ophthalmoplegic, or basilar migraine)
- have had a heart attack
- have had a stroke or transient ischemic attack (TIA)
- have heart disease (e.g., atherosclerosis, heart valve disease, abnormal heart rhythms, congenital heart disease)
- have high blood pressure that is severe or not under control
- have severely reduced liver function
- have taken another 5-hydroxytryptamine agonist (i.e., almotriptan, eletriptan, frovatriptan, naratriptan, sumatriptan, zolmitriptan) in the previous 24 hours
- have taken any medications belonging to the class of medications known as MAO inhibitors (see “What other drugs could interact with this medication?” below) in the previous 2 weeks
- have taken an ergotamine-containing or ergot-type medication (such as dihydroergotamine, ergotamine, or methysergide) in the previous 24 hours
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- dry mouth
- hot flashes
- nausea or vomiting
- shortness of breath
- changes in the way things taste
- unusual tiredness or muscle weakness
Although most of these side effects listed below don’t happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- muscle pain
- pain, pressure, or tightness in the chest, neck, throat, jaw, or arms that does not go away
- sensation of burning, warmth, heat, numbness, tightness, or tingling
Stop taking the medication and seek immediate medical attention if any of the following occur:
- heart attack (symptoms include pain, pressure, tightness, or heaviness in the chest, jaw, neck, or shoulder; sweating; or shortness of breath)
- increased or decreased heart rate
- irregular or fast heartbeat
- severe allergic reaction (symptoms include swelling of the face or throat, hives, or difficulty breathing)
- stroke (symptoms include sudden numbness or weakness, especially on one side of the body; sudden confusion or problems with speech; sudden vision problems in one or both eyes; sudden dizziness or loss of coordination; sudden severe headache, especially if it seems different from your usual headaches)
- sudden or severe abdominal pain
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
- Allergic reactions: Rarely, severe allergic reactions to rizatriptan may occur. Because of the possibility of an allergic reaction, people who are allergic to any of the other medications in this class (5-hydroxytryptamine agonists, also called triptans) should not use rizatriptan.
- Blood pressure: Rizatriptan may cause an increase in blood pressure. People with severe or uncontrolled high blood pressure should not take rizatriptan.
- Drowsiness/reduced alertness: This medication may cause drowsiness or dizziness, which may impair your ability to operate a vehicle or engage in dangerous activities that require alertness.
- Heart and blood vessel disease: This medication may cause narrowing of the blood vessels that supply the heart and brain. This can lead to chest pain (angina), heart attacks, heart rhythm problems, stroke, transient ischemic attack (TIA or “mini-stroke”), and other heart or blood vessel problems. For this reason, rizatriptan should not be used by people with heart or blood vessel disease.
- If you have certain risk factors for heart disease (e.g., high blood pressure, high cholesterol, smoking, obesity, diabetes, family history of coronary artery disease, menopause, men over 40 years of age), tell your doctor.
- Kidney function: You should be closely monitored by your doctor if you are on dialysis and using this medication.
- Liver function: Rizatriptan should not be used by people with severely reduced liver function. If you have moderately reduced liver function, you should be closely monitored by your doctor while taking this medication.
- Medication overuse headaches: As with other pain relief medications, overuse of rizatriptan may lead to medication overuse headaches, or “rebound headaches” where the headache returns as the medication wears off. Avoid taking more of this medication than is recommended by your doctor. If you experience more frequent headaches, contact your doctor as soon as possible.
- Phenylketonuria: The rapidly-dissolving wafer form of this medication contains phenylalanine.
- Seizures: There have been rare reports of seizures experienced by people taking this medication. Most of these people had a previous history of epilepsy or medical conditions that increase the risk of seizures. If you have a history of epilepsy or other conditions that increase the risk for seizure, you should be closely monitored by your doctor while you are taking this medication.
- Serotonin syndrome: This medication may cause a rare but potentially life-threatening condition called serotonin syndrome, especially when used with other medications that increase serotonin levels (e.g., other triptans, fluoxetine, paroxetine, venlafaxine). If you experience symptoms such as agitation, confusion, hallucinations, fast heart rate, fever, lack of coordination, increased body temperature, overactive reflexes, nausea, vomiting, and diarrhea, get immediate medical attention.
- Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
- Breast-feeding: It is not known if rizatriptan passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
- Children: The safety and effectiveness of using this medication have not been established for children.
- Seniors: The safety and effectiveness of rizatriptan have not been adequately studied in people over 65 years. Its use in this age group is not recommended.
What other drugs could interact with this medication?
There may be an interaction between rizatriptan and any of the following:
- amphetamines (e.g., dextroamphetamine, lisdexamphetamine)
- anti-psychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzepine, quetiapine, risperidone)
- ergotamine-containing or ergot-type medication if taken at the same time or within the previous 24 hours (e.g., dihydroergotamine or methysergide)
- monoamine oxidase inhibitors if taken at the same time or within 14 days of taking rizatriptan (e.g., phenelzine, tranylcypromine, selegiline, moclobemide, rasagiline)
- other 5-hydroxytryptamine agonists if taken at the same time or within the previous 24 hours (e.g., sumatriptan, naratriptan, zolmitriptan)
- St. John’s wort
- serotonin antagonists (e.g., granisetron, ondansetron)
- SNRI antidepressants (e.g., duloxetine, desvenlafaxine, venlafaxine)
- SSRI antidepressants (e.g., fluoxetine, fluvoxamine, paroxetine, sertraline)
- tricyclic antidepressants (e.g., amitriptyline, imipramine, nortriptyline)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.