Rizatriptan Dosing for Migraine When Combined with NSAIDs and Acetaminophen
The recommended dose of rizatriptan for migraine treatment when added to NSAIDs and acetaminophen is 10 mg, with a maximum daily dose not exceeding 30 mg in any 24-hour period. 1
Standard Dosing Guidelines
- The standard starting dose of rizatriptan is either 5 mg or 10 mg for acute treatment of migraines in adults 1
- The 10 mg dose provides greater efficacy than the 5 mg dose, but may have a higher risk of adverse reactions 1, 2
- If migraine headache returns, a second dose may be administered 2 hours after the first dose 1
- The safety of treating more than four headaches in a 30-day period has not been established 1
Combination Therapy Considerations
- Combination therapy of a triptan (rizatriptan) with NSAIDs or acetaminophen has demonstrated greater net benefit than triptan monotherapy 3
- The combination of rizatriptan and acetaminophen shows directionally favorable effects compared to triptan monotherapy, though differences may not be statistically significant 3
- Combination therapy of triptan and acetaminophen, compared with acetaminophen monotherapy, results in a higher likelihood of pain freedom at 2 hours (300 more events per 1000 treated people) 3
Special Dosing Considerations
- For patients taking propranolol, only the 5 mg dose of rizatriptan is recommended, up to a maximum of 3 doses in any 24-hour period (15 mg total) 1
- Treatment should begin as early as possible during the migraine attack to improve efficacy 4
- Non-oral routes of administration may be preferred when significant nausea or vomiting is present 4
Efficacy and Safety Profile
- At 2 hours after dosing with rizatriptan 10 mg, up to 77% of patients experience pain relief compared with 37% taking placebo 2
- Up to 44% of patients are completely pain free at 2 hours compared with 7% taking placebo 2
- The most common side effects (incidence ≥2%) occur in <10% of patients, are typically transitory (2-3 hours), and are mild to moderate 2
- Common adverse events include dizziness, somnolence, asthenia/fatigue, and nausea 5, 6
Combination Therapy Benefits
- Combination therapy of a triptan and an NSAID or acetaminophen is recommended for patients with inadequate response to NSAIDs and acetaminophen monotherapies 3
- The American College of Physicians recommends combination therapy of a triptan and an NSAID or acetaminophen as having greater net benefit than triptan monotherapy 3
- Patients generally prioritize effectiveness on pain outcomes over accompanying symptoms, potential harms, or other treatment attributes 3
Important Cautions
- Monitor for medication overuse headache, which can occur with frequent use of acute medications (≥15 days per month with most medications; ≥10 days per month with triptans) 7, 8
- Avoid opioids and butalbital-containing medications for routine migraine treatment due to risk of dependency, rebound headaches, and eventual loss of efficacy 7, 8
- Triptans are contraindicated in patients with uncontrolled hypertension, coronary artery disease, and basilar or hemiplegic migraine 8