Can rizatriptan (triptan) and sumatriptan (triptan) be taken together?

Can Rizatriptan and Sumatriptan Be Taken Together?

No, rizatriptan and sumatriptan should not be taken together—they are both triptans (5-HT1B/1D receptor agonists) and taking them simultaneously increases the risk of serious cardiovascular events including coronary vasospasm, myocardial infarction, and stroke without providing additional therapeutic benefit. 1, 2

Contraindication and Timing Requirements

The FDA explicitly contraindicates taking any triptan within 24 hours of another triptan. 1, 2 This includes:

• Rizatriptan should not be taken within 24 hours of sumatriptan 2
• Sumatriptan should not be taken within 24 hours of rizatriptan 1
• This 24-hour washout period applies to all triptan medications (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan) 1, 2

Mechanism of Harm

Both medications work through the same mechanism—they are selective serotonin 5-HT1B/1D receptor agonists that cause vasoconstriction of intracranial blood vessels 3. Taking them together creates:

• Additive vasoconstrictive effects on coronary arteries, increasing risk of myocardial ischemia and infarction 1, 2
• Increased risk of cerebrovascular events including stroke 1, 2
• Elevated risk of peripheral vascular ischemia affecting limbs and gastrointestinal tract 1, 2
• Potential for serotonin syndrome, though this risk is higher when triptans are combined with SSRIs/SNRIs rather than with each other 3

Clinical Management Algorithm

If a patient has taken one triptan and the headache persists or recurs:

1. Wait the full 24 hours before switching to a different triptan 1, 2

2. For same-day rescue therapy, use a non-triptan alternative:

   • IV or IM ketorolac 30-60 mg 4
   • IV metoclopramide 10 mg 4
   • IV prochlorperazine 10 mg 4
   • Dihydroergotamine (DHE) nasal spray or IV (though DHE also requires 24-hour separation from triptans) 3, 4

3. If the first triptan dose provides partial relief, the same triptan can be repeated:

   • Sumatriptan: second dose allowed 2 hours after first dose, maximum 200 mg/24 hours 1
   • Rizatriptan: second dose allowed 2 hours after first dose, maximum 30 mg/24 hours 2

Critical Pitfall to Avoid

Never allow patients to "stack" different triptans in the same 24-hour period, even if the first triptan failed. 1, 2 The Society for Perioperative Assessment and Quality Improvement consensus recommends that if one triptan fails after adequate trials (2-3 headache episodes), switch to a different triptan for future attacks, not the same attack 3. The pharmacological differences between triptans (rizatriptan reaches peak concentration in 60-90 minutes vs. 2-3 hours for most other triptans) mean that failure of one does not predict failure of another—but this switching must occur across different migraine episodes, not within the same 24-hour window 3, 5, 6.