Maximum Recommended Dose of Rizatriptan (Maxalt) in a 24-Hour Period

The maximum daily dose of rizatriptan should not exceed 30 mg in any 24-hour period. 1

Dosing Guidelines for Adults

The recommended starting dose of rizatriptan is either 5 mg or 10 mg for the acute treatment of migraines in adults 1
If the migraine headache returns, a second dose may be administered 2 hours after the first dose 1
The 10 mg dose may provide a greater effect than the 5 mg dose, but may have a greater risk of adverse reactions 1, 2
Rizatriptan can be taken every two hours as needed, but should not exceed the maximum daily dose of 30 mg 3, 1

For adult patients taking propranolol, only the 5 mg dose of rizatriptan is recommended 1
The maximum daily dose for patients on propranolol is 15 mg (three 5 mg doses in a 24-hour period) 1
This dosage adjustment is necessary due to drug interactions between propranolol and rizatriptan 1

For pediatric patients weighing less than 40 kg (88 lb), the recommended dose is 5 mg 1
For pediatric patients weighing 40 kg (88 lb) or more, the recommended dose is 10 mg 1
The efficacy and safety of treatment with more than one dose of rizatriptan within 24 hours has not been established in pediatric patients 6 to 17 years of age 1

The safety of treating, on average, more than four headaches in a 30-day period has not been established 1
Common adverse effects include dizziness, somnolence, fatigue, chest pressure/tightness, and nausea 1, 2
Rizatriptan is contraindicated in patients with:
- Heart problems or history of heart problems 1
- History of stroke or transient ischemic attack (TIA) 1
- Blood vessel problems including ischemic bowel disease 1
- Uncontrolled hypertension 1
- Use of other triptan medications within the past 24 hours 1
- Use of ergot-containing medications within the past 24 hours 1
- Hemiplegic or basilar migraines 1
- Use of monoamine oxidase (MAO) inhibitors within the past 2 weeks 1

Rizatriptan has shown greater efficacy than placebo in providing pain relief, pain-free status, relief from associated symptoms, and normal functional ability 2, 4
Studies indicate that rizatriptan 10 mg provides faster pain relief and a higher percentage of patients with pain-free status at 2 hours compared to some other triptans 4
If one triptan is ineffective for a patient, a different triptan should be tried 3
Patients should try a medication for 2-3 headache episodes before abandoning that line of therapy 3

If rizatriptan is ineffective after dose optimization, consider switching to another triptan 5
For patients with severe nausea or vomiting, consider using a non-oral triptan formulation 5
Rizatriptan is available as both traditional tablets and orally disintegrating tablets (Maxalt MLT) 1