Section 02 · Monograph

Rizatriptan

Reviewed Nov 2026FDA label

MaxaltTriptan

Indications

Acute treatment of migraine with or without aura in adults and pediatric patients 6-17 yearsFDA-labeled

Selective agonist at 5-HT1B/1D receptors on intracranial extracerebral blood vessels and trigeminal sensory nerves
Produces cranial vasoconstriction and inhibits release of vasoactive/pro-inflammatory neuropeptides (e.g., CGRP) from trigeminal afferents

Adults: 5mg or 10mg single dose (tablet or MLT orally-disintegrating tablet); may repeat once after ≥2 hours if headache recurs
Maximum: 30mg (3 doses) in 24 hours
Concomitant propranolol: propranolol increases rizatriptan plasma levels ~70% — use only the 5mg dose, up to a maximum of 3 doses (15mg) in 24 hours
MLT (orally-disintegrating) formulation dissolves on the tongue without water and is bioequivalent to the conventional tablet
No proven benefit from a second dose if the first dose was ineffective for a given attack

Pediatric (6-17y): weight-based — 5mg if <40kg, 10mg if ≥40kg, single dose; do not exceed 1 dose in 24 hours

Ischemic or vasospastic coronary artery disease (e.g., Prinzmetal's angina)
History of stroke, TIA, or peripheral vascular disease
Ischemic bowel disease
Uncontrolled hypertension
Hemiplegic or basilar migraine
Use of another 5-HT1 agonist (triptan) or ergotamine-type medication within 24 hours
Use of an MAO-A inhibitor within the preceding 2 weeks
Known hypersensitivity to rizatriptan

Propranolol raises rizatriptan AUC significantly — mandates reduced 5mg dosing
MAO-A inhibitors markedly increase rizatriptan and metabolite exposure — contraindicated
SSRIs/SNRIs: increased risk of serotonin syndrome
Other triptans or ergot-containing drugs within 24 hours: additive vasospastic risk — contraindicated
Relatively short half-life (~2-3 hours) limits duration of drug-drug interaction exposure windows compared to longer-acting triptans

Common: asthenia/fatigue, somnolence, dizziness, paresthesia, chest/neck/throat pressure sensation
Serious (rare, class-wide): myocardial infarction, ventricular arrhythmia, coronary vasospasm, cerebrovascular events, serotonin syndrome, medication-overuse headache

Cardiovascular risk assessment before first dose in patients with risk factors for coronary artery disease
Blood pressure, particularly with repeated or high-dose use
Frequency of use — limit to avoid medication-overuse headache

Use only if potential benefit justifies potential fetal risk
Rizatriptan pregnancy registry data limited; not known to be teratogenic in available data
Present in animal milk; caution advised with breastfeeding — limited human lactation data