How It Works
Rizatriptan belongs to a class of drugs known as triptans, or more specifically, selective serotonin (5-HT1) receptor agonists.Rizatriptan works by attaching to serotonin receptors located on the blood vessels and nerves within the brain. This causes the widened blood vessels in the brain to narrow and tighten, helping to ease the throbbing pain associated with migraines. It also interrupts pain signals and blocks the release of proteins that cause inflammation.
Together, these effects provide relief from the headache itself as well as associated symptoms like nausea and sensory sensitivity.Clinical data suggest rizatriptan usually starts working within 30 minutes.
| Quick Facts | |
|---|---|
| Common Brands | Maxalt, Maxalt-MLT |
| Drug Class | Triptan (selective serotonin 5-HT1 receptor agonist) |
| Generic Status | Generic for Maxalt, Maxalt-MLT |
| Availability | Prescription only |
Dosing
Rizatriptan is generally available in two forms: a standard oral tablet that is swallowed whole with water, and an orally disintegrating tablet (ODT) that dissolves on the tongue without the need for liquid.
- The recommended dose for adults is 5 mg or 10 mg taken at the first sign of a migraine.
- If the migraine symptoms improve but then return, or if they do not fully resolve, a second dose may be taken. It’s recommended to wait at least 2 hours after the first dose before taking a second.
- The maximum dosage within a 24-hour period is 20 mg.
- To prevent medication-overuse headaches (also known as rebound headaches), rizatriptan should not be used for more than 4 migraines per month.
Note: Dosing information is educational only. Your prescribing physician will determine your specific dose based on your individual health needs. Always follow your healthcare provider’s instructions for exact dosing.
Uses
FDA-Approved Uses
Rizatriptan is FDA-approved to treat migraines, with or without aura.
Off-Label Uses
You may see rizatriptan prescribed for uses that are not “FDA-approved.” This is a very common and legal practice called “off-label” prescribing, where a doctor uses their clinical judgment to prescribe a drug for a different (but well-researched) purpose.
There are currently no common off-label uses.
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Side Effects
Like all medications, rizatriptan can cause side effects. Some common side effects may improve over time as your body adjusts to the medication. Other side effects may be serious and require medical attention.
Common Side Effects
- Fatigue
- Loss of energy
- Dizziness
- Tingling
- Flushing
- Drowsiness
Serious Side Effects
Serious side effects are rare, but it’s important to know what to look for if they do occur. Stop using rizatriptan and call your doctor immediately if you experience:
- Severe allergic reactions: Symptoms include swelling of the face, lips, tongue, or throat; difficulty breathing or swallowing; severe rash or itching; fever.
- Heart attack or stroke: Symptoms include chest pain or pressure, tightness in the jaw or arm, fast heartbeat, trouble breathing, sweating, dizziness, slurred speech, sudden and severe headache, or weakness on one side of the body.
- Abnormal heart rhythm (arrhythmia): Symptoms include irregular heartbeat, fainting, shortness of breath, lightheadedness, and chest pain.
- Serotonin syndrome: Symptoms include agitation, hallucinations, rapid heart rate, sweating, fever, confusion, seizures, nausea, vomiting, dizziness, and muscle stiffness or twitching.
- Reduced blood flow (ischemia): Symptoms include severe or sudden stomach pain; constipation; bloody diarrhea; vomiting; fever; nausea; pain, tightness, numbness, or tingling in the legs, hips, fingers, or toes; changes in color in the fingers or toes (Raynaud’s syndrome).
- Medicine overuse headache: Taking rizatriptan more often than prescribed or more than 4 times per 30-day period can cause headaches to worsen or occur more frequently.
Call your doctor immediately if you experience any concerning or prolonged symptoms.
Pharmacist Tips
Take with Food
Rizatriptan can be taken with or without food, but if you find it upsets your stomach, taking it with a small amount of food may help.
Avoid Alcohol
It is recommended to avoid drinking alcohol while taking rizatriptan, as it can worsen side effects like dizziness or drowsiness and may even trigger migraine attacks in some individuals.
Timing is Key
It’s recommended to take rizatriptan at the very first sign of a migraine attack.
Handling ODTs
If you are prescribed the orally disintegrating tablet (Maxalt-MLT), ensure your hands are dry before handling the blister pack. Peel back the foil rather than pushing the tablet through, as it can break. Place it on your tongue and let it dissolve.
Driving Precautions
Because rizatriptan can cause dizziness, drowsiness, or fatigue, avoid driving or operating heavy machinery until you know how the medication affects you.
Avoid Overuse
Rizatriptan should not be used for more than 4 migraines (or 10 days) in a month. Frequent use may lead to medication overuse headaches, making migraines worse over time.
Keep a Journal
It may be helpful to keep a log of your migraine attacks so you and your healthcare provider can see how well rizatriptan is working for you. You can also use a journal to note any migraine triggers.
Missed Dose
Rizatriptan should only be used as needed to treat a migraine that has started. Don’t double up on doses of rizatriptan.
Drug Interactions
Certain medications and substances can interact with rizatriptan, potentially altering how it works or increasing the risk of side effects. For example:
- MAO inhibitors (MAOIs): You should not take rizatriptan if you are taking or have taken an MAOI (such as phenelzine or tranylcypromine) within the last 2 weeks.
- Other migraine medications: Triptans and ergot-containing drugs used to treat migraine should not be combined with rizatriptan to avoid excessive blood vessel narrowing.
- Antidepressants (SSRIs/SNRIs): Combining rizatriptan with certain antidepressants (like fluoxetine, sertraline, or venlafaxine) increases the risk of Serotonin Syndrome.
- Propranolol: This beta-blocker used for heart conditions or migraine prevention can significantly increase the amount of rizatriptan in your body. Your doctor may need to adjust your rizatriptan dose if you are taking propranolol.
Always give your doctor and pharmacist a complete list of all your medications, vitamins, and supplements to check for potential interactions.
FAQs
How quickly does rizatriptan work to stop a migraine?
Rizatriptan may begin to relieve pain and other migraine symptoms within 30 minutes. While individual results may vary, it is generally considered to be a fast-acting medication.
What is the difference between rizatriptan tablets and Maxalt-MLT?
The primary difference is the formulation. Regular rizatriptan tablets are swallowed whole with liquid. Maxalt-MLT (or the generic rizatriptan ODT) is an orally disintegrating tablet that dissolves on the tongue without water and may be preferred for patients who experience nausea with migraines.
Why does my doctor need to know if I take propranolol before prescribing rizatriptan?
Propranolol can slow the breakdown of rizatriptan in the body, leading to higher levels of the drug in your system. This increases the risk of side effects. If you take propranolol, your doctor may prescribe a lower dose of rizatriptan or choose an alternative medication to ensure safety.
Can I take a second dose of rizatriptan if the migraine comes back?
Yes, if you experienced relief from the first dose but the headache returns, or if the first dose did not fully resolve the pain, your healthcare provider may recommend taking a second dose of rizatriptan. However, you must wait at least 2 hours after the first dose before taking a second dose. Do not exceed the maximum daily dose recommended by your provider.
Does rizatriptan prevent migraines or just treat them?
Rizatriptan is strictly a treatment for acute migraine attacks that have already started. It is not used to prevent or reduce the number of migraine headaches you experience. If you suffer from frequent migraines, talk to your doctor about preventative treatment options.
Can I take ibuprofen or naproxen at the same time as rizatriptan?
Generally, yes. Rizatriptan works differently than NSAIDs like ibuprofen or naproxen, and they are not known to have negative interactions with each other. But, NSAIDs may have other side effects that may make them unsafe for you. Ask your healthcare provider before combining rizatriptan with ibuprofen or naproxen.
Can I drive after taking rizatriptan?
Rizatriptan can cause drowsiness, dizziness, or fatigue. It’s recommended to avoid driving or operating machinery until you know how the medication affects you.
What is “medication overuse headache” and can rizatriptan cause it?
Medication overuse headache (also called rebound headache) is a condition where headaches happen more frequently or worsen due to taking triptan medication too often. The risk of this increases if rizatriptan is used more than 10 days (or for 4 migraines) per month.
Can I take rizatriptan for a regular tension headache?
No. Rizatriptan is specifically indicated for migraines. It may not be effective for other types of pain or tension headaches that do not share the specific features of a migraine.
Does rizatriptan contain aspartame?
The orally disintegrating tablets (Maxalt-MLT and generic rizatriptan ODT) typically contain phenylalanine, a component of aspartame. People with phenylketonuria (PKU) should not take the ODT version of rizatriptan.
Can I take rizatriptan if I am on antidepressants (SSRIs or SNRIs)?
You should discuss this with your doctor. Taking rizatriptan with SSRIs (like Zoloft or Prozac) or SNRIs (like Cymbalta) can increase the risk of Serotonin Syndrome.
What is the maximum dosage of rizatriptan in a 24-hour period?
The maximum dosage of rizatriptan in a 24-hour period is 20 mg total (two 10 mg doses, separated by at least 2 hours).
Can I drink alcohol after taking rizatriptan?
It’s recommended to avoid drinking alcohol after taking rizatriptan. Alcohol can trigger migraines in some people and may worsen certain side effects of rizatriptan, such as drowsiness or dizziness.
Does rizatriptan expire quickly?
Like all medications, rizatriptan has an expiration date printed on the packaging. Do not use medication past this date. Store it at room temperature (59°F to 86°F) in a dry place to maintain its stability.
Why shouldn’t I push the ODT tablet through the foil blister pack?
The orally disintegrating tablets are fragile. Pushing them through the foil can crush or break the tablet, making it difficult to take the correct dose. You should peel back the foil to remove the tablet gently.
Comparable Medications
Rizatriptan, Sumatriptan (Imitrex), Naratriptan (Amerge), Rimegepant (Nurtec ODT), or Lasmiditan (Reyvow)?
There are several medications that your doctor can prescribe in place of rizatriptan. Here are a few possible alternatives below.
Sumatriptan
From $27.59
A triptan available in oral, nasal, and injectable forms that’s used to treat migraine with or without aura.
Naratriptan Tablets
From $74.99
An oral triptan used to treat migraine with or without aura.
Rimegepant (Nurtec ODT)
An oral CGRP receptor agonist used to treat migraine with or without aura and to prevent episodic migraines.
Lasmiditan (Reyvow)
A ditan used to treat migraine with or without aura. It’s classified as a Schedule V Controlled Substance.
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Important: Information on this page is for educational purposes only. Prescribing decisions are made by independent, licensed providers. TelyRx operates technology-enabled pharmacies and a telehealth platform that connects patients with board-certified licensed providers. Prescriptions, when provider-approved and issued, are filled and shipped by TelyRx-affiliated pharmacies. We do not employ physicians or make prescribing decisions. Learn more about our editorial standards here.