From the Guidelines
Rizatriptan (Maxalt) is recommended as an abortive therapy for migraines, with a strong recommendation based on recent evidence. It belongs to a class of medications called triptans that work by narrowing blood vessels in the brain and blocking pain pathways. According to the 2024 clinical practice guideline for the management of headache 1, rizatriptan is one of the recommended options for the short-term treatment of migraine, along with other triptans such as eletriptan, frovatriptan, and sumatriptan.
The medication should be taken as soon as migraine symptoms appear for maximum effectiveness, but not as a preventive measure. The standard adult dose is 5-10mg, with a maximum of 30mg in a 24-hour period. Patients should wait at least two hours between doses. Rizatriptan is specifically designed to stop an ongoing migraine attack rather than prevent future attacks. It works by affecting serotonin receptors, reducing inflammation and constricting blood vessels that have become abnormally dilated during a migraine.
Some key points to consider when prescribing rizatriptan include:
- Contraindications: patients with certain cardiovascular conditions, such as ischemic vascular conditions, vasospastic coronary disease, uncontrolled hypertension, or other significant cardiovascular disease, should not use rizatriptan 2.
- Side effects: may include dizziness, drowsiness, and chest tightness 2.
- Interactions: rizatriptan should not be used within 24 hours of taking other triptans or ergot-containing medications 2.
- Dosage: the standard adult dose is 5-10mg, with a maximum of 30mg in a 24-hour period 2.
Overall, rizatriptan is a effective and recommended option for the abortive treatment of migraines, but it should be used with caution and under the guidance of a healthcare professional.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Rizatriptan (Maxalt) as Abortive Therapy
- Rizatriptan is used as an abortive therapy for migraine treatment, as it is a selective 5-hydroxytriptamine1B/1D receptor agonist that effectively relieves headache pain and associated migraine symptoms 3.
- The drug is available in various formulations, including oral tablets, orally disintegrating tablets, and is considered a useful alternative to conventional oral tablets for patients who have difficulty swallowing pills or prefer not to do so 4.
- Rizatriptan has been shown to be effective in providing pain relief, an absence of pain, relief from associated symptoms, normal functional ability, and an improvement in patient quality of life 5.
- Compared to other triptans, rizatriptan has been found to have a faster onset of action and greater efficacy, with a higher percentage of patients achieving pain-free responses 6, 7.
- The efficacy of rizatriptan is retained when used in the long term, and the drug is generally well tolerated, with common side effects being mild and transient 5, 3.
Comparison with Other Triptans
- Rizatriptan has been compared to other triptans, including sumatriptan, zolmitriptan, naratriptan, almotriptan, frovatriptan, and eletriptan, and has been found to have a faster onset of action and greater efficacy than some of these drugs 6, 7.
- Eletriptan has been found to be the most effective triptan, with rizatriptan yielding the second highest treatment effects 6.
- The choice of triptan depends on the patient's individual needs and preferences, as well as the characteristics of their migraine attacks 7.