Rizatriptan (Maxalt) Dosage and Usage for Acute Migraine Treatment
The recommended starting dose of rizatriptan for acute migraine treatment in adults is either 5 mg or 10 mg, with the 10 mg dose providing greater efficacy but potentially more side effects. The maximum daily dose should not exceed 30 mg in any 24-hour period. 1
Adult Dosing Guidelines
- Initial dose: 5 mg or 10 mg orally at migraine onset 1
- Redosing: If migraine returns, a second dose may be administered 2 hours after the first dose 1
- Maximum daily dose: 30 mg in any 24-hour period 1
- Dosing interval: Can be taken every two hours as needed, not exceeding maximum daily dose 2, 3
- The 10 mg dose is generally more effective than the 5 mg dose for pain relief 1, 4
Special Dosing Considerations
Patients Taking Propranolol
- Adults on propranolol: Only 5 mg dose is recommended, up to maximum of 3 doses in 24 hours (15 mg total) 1
- Pediatric patients ≥40 kg on propranolol: Only a single 5 mg dose (maximum 5 mg in 24 hours) 1
- Not recommended for propranolol-treated pediatric patients weighing <40 kg 1
Pediatric Patients (Age 6-17 years)
- Patients <40 kg (88 lb): 5 mg dose 1
- Patients ≥40 kg (88 lb): 10 mg dose 1
- Multiple dosing within 24 hours has not been established as safe in pediatric patients 1
Administration Options
- Standard oral tablets 1
- Orally disintegrating tablets (Maxalt MLT) - beneficial when nausea/vomiting are present 2
Treatment Approach
- Try rizatriptan for 2-3 migraine episodes before determining effectiveness 2, 3
- If one triptan is ineffective, try a different triptan 2, 3
- For moderate to severe migraines or mild to moderate migraines that respond poorly to NSAIDs, triptans like rizatriptan are recommended 2
Safety Considerations
Contraindications
- Concurrent use with ergotamine derivatives 2
- Use within 24 hours of another triptan 2
- Hemiplegic or basilar migraine 2
- Coronary artery disease 2
- MAOIs (monoamine oxidase inhibitors) 2
- Impaired hepatic function 2
- Pregnancy 2
Common Side Effects
- Dizziness, drowsiness, and asthenia/fatigue (typically mild to moderate and short-lasting) 5, 4
- Chest pressure and heaviness 2
- Throat tightness 2
- Nausea 4
Clinical Efficacy
- Rizatriptan provides rapid onset of action with pain relief beginning as early as 30 minutes after dosing 6
- At 2 hours post-dose, up to 77% of patients taking rizatriptan 10 mg experience pain relief compared to 37% with placebo 7
- Up to 44% of patients are completely pain-free at 2 hours compared to 7% with placebo 7