Rizatriptan Dosage for Adults with Migraine
For adults with migraine, start with rizatriptan 10 mg at the onset of headache symptoms, which can be repeated once after 2 hours if needed, with a maximum of 30 mg in 24 hours. 1
Standard Dosing Regimen
The recommended starting dose is either 5 mg or 10 mg, but the 10 mg dose provides greater efficacy with best consistency (67% response in ≥2 of 3 attacks), though it carries a slightly higher risk of adverse reactions compared to the 5 mg dose 2, 1
If the migraine returns after initial response, a second dose may be administered 2 hours after the first dose 1
The maximum daily dose is 30 mg in any 24-hour period 1
Critical Timing Strategy
Take rizatriptan early when the headache is still mild for maximum effectiveness—do NOT take during the aura phase as there is no evidence of benefit 2
Trial rizatriptan for 2-3 migraine episodes before determining if it's effective for you, as recommended by the American Academy of Family Physicians 3
Rizatriptan can be taken every two hours as needed, not exceeding the maximum daily dose 3
Special Formulation Option
- Orally disintegrating tablets (Maxalt MLT) are beneficial when nausea or vomiting are present, as they don't require water for administration 2, 3
Important Dosage Adjustment
- For patients taking propranolol: use only the 5 mg dose, up to a maximum of 3 doses in 24 hours (15 mg total) due to drug interaction that increases rizatriptan levels 1
When to Escalate or Combine
If rizatriptan monotherapy is insufficient, combine with a fast-acting NSAID (naproxen sodium, ibuprofen lysine, or diclofenac potassium) 2
If one triptan fails after adequate trial, try a different triptan—different triptans work for different patients 3
Common Pitfalls to Avoid
Do not use more than 4 headaches worth of treatment in a 30-day period on average, as the safety of more frequent use has not been established and risks medication overuse headache 1, 3
Rizatriptan is contraindicated within 24 hours of another triptan or ergotamine derivative 3
Absolute contraindications include coronary artery disease, hemiplegic or basilar migraine, uncontrolled hypertension, concurrent MAOI use (within 2 weeks), and pregnancy 3
Expected Efficacy
At 2 hours after the 10 mg dose, up to 77% of patients achieve pain relief and up to 44% are completely pain-free, compared to 37% and 7% with placebo respectively 4
Common side effects include chest pressure and heaviness, throat tightness, dizziness, drowsiness, and asthenia/fatigue, which are typically transitory (2-3 hours) and mild to moderate 3, 4