(ri-za-trip'tan ben'zo-ate)
Maxalt, Maxalt-MLT
Classifications: serotonin 5-ht1 receptor agonist;

Prototype: Sumatriptan
Pregnancy Category: C


5 mg, 10 mg tablets; 5 mg, 10 mg disintegrating tablets


Selective (5-HT1B/1D) receptor agonist. The agonist effects at 5-HT1B/1D reverse the vasodilation of cranial blood vessels associated with a migraine.

Therapeutic Effect

Activation of the 5-HT1B/1D receptors reduces the pain pathways associated with the migraine headache as well as reversing vasodilation of cranial blood vessels.


Acute migraine headaches with or without aura.


Hypersensitivity to rizatriptan; CAD; Prinzmetal's angina (potential for vasospasm); ischemic heart disease; risk factors for CAD such as hypertension, hypercholesterolemia, obesity, diabetes, smoking, and strong family history; concurrent administration with ergotamine drugs or sumatriptan; concurrent administration with MAOIs; basilar or hemiplegic migraine; pregnancy (category C).

Cautious Use

Hypersensitivity to sumatriptan; renal or hepatic impairment; lactation; hypertension; asthmatic patients. Safety and effectiveness in patients <18 y are not established.

Route & Dosage

Acute Migraine
Adult: PO 5–10 mg, may repeat in 2 h if necessary (max: 30 mg/24 h); 5 mg with concurrent propranolol (max: 15 mg/24 h)


  • Give any time after symptoms of migraine appear. If symptoms return, a second tablet may be given but no sooner than 2 h after the first.
  • Do not exceed 30 mg (three doses) in any 24 h period.
  • Do not give within 24 h of an ergot-containing drug or another 5-HT1 agonist.
  • Store at 15°–30° C (59°–86° F) and protect from light and moisture.

Adverse Effects (≥1%)

Body as a Whole: Asthenia, fatigue, pain, pressure sensation, paresthesias, throat pressure, warm/cold sensations. CNS: Somnolence, dizziness, headache, hypesthesia, decreased mental acuity, euphoria, tremor. CV: Coronary artery vasospasm, transient myocardial ischemia, MI, ventricular tachycardia, ventricular fibrillation, chest pain/tightness/heaviness, palpitations. GI: Dry mouth, nausea, vomiting, diarrhea. Respiratory: Dyspnea. Skin: Flushing. Endocrine: Hot flashes.


Drug: Propranolol may increase concentrations of rizatriptan, use smaller rizatriptan doses; dihydroergotamine, methysergide, other 5-ht1 agonists may cause prolonged vasospastic reactions; ssris have rarely caused weakness, hyperreflexia, and incoordination; maois should not be used with 5-HT1 agonists. Herbal: St. John's wort may increase triptan toxicity.


Absorption: 45% of oral dose reaches systemic circulation. Peak: 1–1.5 h for oral tabs; 1.6–2.5 h for orally disintegrating tablets. Metabolism: Via oxidative deamination by monoamine oxidase A. Elimination: Primarily in urine (82%). Half-Life: 2–3 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor cardiovascular status carefully following first dose in patients at risk for CAD (e.g., postmenopausal women, men >40 y, persons with known CAD risk factors) or coronary artery vasospasms.
  • ECG is recommended following first administration of rizatriptan to someone with known CAD risk factors.
  • Report immediately to physician: chest pain or tightness in chest or throat that is severe or does not quickly resolve.
  • Monitor periodically cardiovascular status with continued rizatriptan use.

Patient & Family Education

  • Do not exceed 30 mg (three doses) in 24 h.
  • Allow orally disintegrating tablets to dissolve on tongue; no liquid is needed.
  • Contact physician immediately if any of the following develop following rizatriptan use: symptoms of angina (e.g., severe and/or persistent pain or tightness in chest or throat), hypersensitivity (e.g., wheezing, facial swelling, skin rash, or hives), abdominal pain.
  • Report any other adverse effects (e.g., tingling, flushing, dizziness) at next physician visit.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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