Rizatriptan for migraine

What rizatriptan is

Rizatriptan is a serotonin (5-HT1B/1D) receptor agonist, or triptan. The Maxalt label indicates it for acute treatment of migraine with or without aura in adults and in patients 6 to 17 years old. It sets three limits of use: only after a clear diagnosis of migraine, not for preventing attacks, and safety and effectiveness not established in cluster headache.

Approval by age and brand differs by country. NICE, for example, noted that triptans other than nasal sumatriptan were off-label in under-18s in the UK as of June 2025.

Tablets and orally disintegrating tablets

The label covers two forms: Maxalt tablets and Maxalt-MLT orally disintegrating tablets. Two label details separate them:

• Absorption. Peak blood levels come at about 1 to 1.5 hours. With the orally disintegrating tablet, absorption is somewhat slower, and the peak is delayed by up to 0.7 hour.
• Phenylalanine. The orally disintegrating tablet contains phenylalanine, from aspartame. This matters for people with phenylketonuria.

The label gives doses by age, weight and interacting medicine. They come from the label or the prescriber.

Results at 2 hours

• Adults. In four placebo-controlled trials, headache response (moderate or severe pain reduced to mild or none) was 60% to 77% across the doses tested, against 23% to 40% with placebo.
• Ages 6 to 17. The pediatric trial enrolled patients who had not responded to NSAIDs and acetaminophen in the past, and randomized only those who did not respond to placebo in a first stage. 33% of evaluable patients on the orally disintegrating tablet had no headache pain at 2 hours, against 24% on placebo (382 and 388 patients).

Contraindications and interactions

The label says rizatriptan must not be used with:

• ischemic coronary artery disease, other significant cardiovascular disease, or coronary vasospasm;
• a history of stroke or transient ischemic attack;
• hemiplegic or basilar migraine;
• peripheral vascular disease, ischemic bowel disease, or uncontrolled hypertension;
• another 5-HT1 agonist, ergotamine or ergot-type medicine within 24 hours;
• an MAO-A inhibitor now or stopped within 2 weeks, or a non-selective MAO inhibitor;
• hypersensitivity to rizatriptan or its excipients.

Propranolol. Propranolol raised rizatriptan exposure (plasma AUC) by 70%, and the label gives separate dosing instructions for people taking it. Propranolol is also a preventive named by NICE, so the two can appear on one medicine list.

SSRIs and SNRIs. The label reports serotonin syndrome when triptans were combined with SSRIs or SNRIs, and also names tricyclic antidepressants and MAO inhibitors.

Other label warnings cover heart attack, arrhythmia, chest or jaw tightness, stroke, reduced blood flow to the bowel or limbs, and raised blood pressure.

Monthly limit

Triptans in any form reach the ICHD-3 limit at 10 or more days a month for more than 3 months. The Maxalt label warns about medication-overuse headache at the same frequency. The medication days counter applies this figure.

In a headache diary

Note which form was taken, the time, and the pain at 2 hours. Keep any propranolol on the same record, including start dates, so a doctor reading it can see both medicines. For a child or teenager, an adult can keep this record, and the pediatric trial outcome to compare with is no pain at 2 hours.