Rizatriptan Dosing for Abortive Migraine Therapy in an 18-Year-Old
The recommended dose of rizatriptan for abortive therapy in an 18-year-old with migraines is 10 mg, with a maximum of 30 mg in a 24-hour period (no more than 3 doses, separated by at least 2 hours). 1
Dosing Guidelines
Initial Dosing
- Standard dose: 10 mg for acute treatment
- Alternative dose: 5 mg may be considered if there are concerns about tolerability
- The 10 mg dose provides greater efficacy than the 5 mg dose, but may have a higher risk of adverse reactions 1
Redosing and Maximum Limits
- If migraine returns, a second dose may be administered 2 hours after the first dose
- Maximum daily dose: 30 mg in any 24-hour period 1
- Safety of treating more than 4 headaches in a 30-day period has not been established 2
Special Considerations
Drug Interactions
- Important: If the patient is taking propranolol, only the 5 mg dose should be used, with a maximum of 3 doses (15 mg total) in a 24-hour period 1
Efficacy and Onset
- Rizatriptan is strongly recommended by the VA/DoD guidelines for short-term treatment of migraine 3
- Onset of effect can be seen as early as 30 minutes after dosing with the 10 mg dose 4
- At 2 hours post-dose, pain relief rates of up to 71% have been observed with the 10 mg dose (compared to 35% with placebo) 4
- Complete pain relief at 2 hours occurs in up to 42% of patients taking the 10 mg dose 4
Administration Options
- Available as standard tablets or orally disintegrating tablets (Maxalt RPD)
- The orally disintegrating formulation may be beneficial for patients with nausea or vomiting, as it can be taken without liquid 5
Safety Profile
- Most common adverse effects are mild and transient (typically lasting 2-3 hours) 6
- Common side effects include:
- Dizziness
- Somnolence
- Asthenia/fatigue
- Nausea 7
Contraindications
- Uncontrolled hypertension
- Coronary artery disease
- Hemiplegic or basilar migraine
- Use within 24 hours of another triptan
- Concurrent use of ergotamine-containing medications
- Use with MAO inhibitors
- Impaired hepatic function 2
Clinical Pearls
- Patients should try rizatriptan for 2-3 headache episodes before determining its effectiveness 3
- If rizatriptan is ineffective, switching to a different triptan may be beneficial 3
- Treating the migraine during the mild pain phase provides better outcomes than waiting until pain is moderate or severe 2
- For patients with significant nausea/vomiting, consider the orally disintegrating tablet formulation or a non-oral route of administration 3
In summary, for an 18-year-old with migraines requiring abortive therapy, rizatriptan 10 mg is the recommended starting dose, with the option to redose after 2 hours if needed, up to a maximum of 30 mg in 24 hours.