RizatriptanRizatriptan Benzoate

About Rizatriptan

Rizatriptan binds to 5-HT1B and 5-HT1D serotonin receptors on blood vessels in the head and on trigeminal sensory nerves. It treats an attack once it has started; it is not for preventing migraine or for hemiplegic or basilar migraine, and its safety and effectiveness in cluster headache have not been established. Adults take 5 or 10 mg; if the headache returns, another dose may follow at least 2 hours later, with no more than 30 mg in 24 hours, and the safety of treating more than four headaches in 30 days has not been established. Children 6 to 17 take a single dose by weight, 5 mg under 40 kg (88 lb) and 10 mg at 40 kg or more; a second dose within 24 hours is not established as safe for them. Propranolol raises rizatriptan levels, so adults taking it use 5 mg, up to three doses (15 mg) in 24 hours; children of 40 kg or more take one 5 mg dose, and children under 40 kg on propranolol should not be prescribed it.

Weakness or tiredness, sleepiness, pain or pressure sensations and dizziness are the most common side effects in adults. Chest, throat, neck or jaw tightness is usually not from the heart, but triptans can rarely cause heart attacks, dangerous rhythms, strokes and spasm of other blood vessels, so someone with several heart risk factors has a heart check first and may take the first dose under supervision. It must not be used with coronary artery or other significant heart disease, coronary spasm, a past stroke or TIA, peripheral vascular or ischemic bowel disease, uncontrolled high blood pressure, hemiplegic or basilar migraine, within 24 hours of another triptan or an ergot, with or within 2 weeks of an MAO-A inhibitor, or with an allergy to it. Other warnings cover serotonin syndrome with SSRI or SNRI antidepressants, rare large rises in blood pressure, and medication-overuse headache from acute migraine medicines used on 10 or more days a month.

Disintegrating tablets stay sealed in their blister inside the outer pouch until the dose is due; the blister is peeled open with dry hands and the tablet placed on the tongue to dissolve and be swallowed with saliva, with no water needed. Maxalt-MLT contains phenylalanine (from aspartame), which matters for people with phenylketonuria. Maxalt 5 mg and Maxalt-MLT 5 mg have been discontinued, while both 10 mg brands are still sold, and generics come in both strengths. Human data are too limited to draw conclusions about birth defects or miscarriage, fetal weights were lower in rats given it, and whether rizatriptan passes into breast milk is not known.

Taking Rizatriptan

How to take it

Take it at the first sign of a migraine. Leave a disintegrating tablet in its blister until the dose is due, peel the blister open with dry hands, and let the tablet dissolve on your tongue; no water is needed. If the first dose does not help at all, call the prescriber before taking another.

If you miss a dose

It is taken only for a migraine attack, so there is no schedule to miss.

Storage

At room temperature in the original package, away from excess heat and moisture (not in the bathroom), out of reach of children. Keep disintegrating tablets in the blister until just before use.

Interactions to know about

Propranolol raises its levels, so the dose is lower. Never within 24 hours of another triptan or an ergot such as dihydroergotamine, or with or within 2 weeks of an MAO-A inhibitor. SSRI and SNRI antidepressants can contribute to serotonin syndrome. Get emergency help for chest pain or pressure, a fast or irregular heartbeat, shortness of breath, or weakness, numbness or trouble speaking.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Rizatriptan differs from pharmacy to pharmacy

Generic tablets have several makers and disintegrating tablets fewer, and the two forms cannot be swapped for each other at the counter. A prescription that names Maxalt or Maxalt-MLT and blocks substitution is priced as a brand.

Fills are often small, and the pharmacy’s dispensing fee applies to each one; Maxalt and Maxalt-MLT come in packs of 18.

Ways to pay less for Rizatriptan without insurance

• Ask for a generic, and check that the prescription does not name Maxalt or Maxalt-MLT only.
• If disintegrating tablets are prescribed and you can swallow tablets, ask the prescriber whether regular tablets would suit you.
• If you treat attacks regularly, ask the prescriber whether a larger quantity per fill suits you, within your monthly limit.
• Compare more than one pharmacy, and ask whether rizatriptan is on a flat-price generic list.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Rizatriptan

1. 1.Does my propranolol, or any other medicine I take, change my dose or my 24-hour limit?
2. 2.Can I take a second dose, and how long after the first?
3. 3.Do my disintegrating tablets contain phenylalanine, and does that matter for me?
4. 4.How many days a month can I use it without risking rebound headaches?

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