What is the recommended dosage of Rizatriptan (Maxalt) for adults with migraines?

Rizatriptan Dosage for Adults with Migraine

The recommended starting dose of rizatriptan for adults is either 5 mg or 10 mg at migraine onset, with the 10 mg dose providing greater efficacy but slightly higher risk of adverse effects; a second dose may be taken 2 hours after the first if headache returns, with a maximum of 30 mg in 24 hours. 1

Standard Dosing Regimen

Initial Dose:

• Start with either 5 mg or 10 mg at the onset of migraine symptoms 1
• The 10 mg dose is more effective than 5 mg, achieving pain-free status in up to 44% of patients at 2 hours compared to 7% with placebo 2
• Take medication early in the attack while pain is still mild for optimal effectiveness 3

Redosing Protocol:

• If migraine returns after initial response, a second dose may be administered 2 hours after the first dose 1
• Maximum daily dose: 30 mg in any 24-hour period 1
• Limit use to no more than 2 days per week to prevent medication-overuse headache 3

Special Dosing Considerations

Patients Taking Propranolol:

• Use only the 5 mg dose, with a maximum of 3 doses (15 mg total) in 24 hours 1
• This adjustment is necessary due to drug interactions that increase rizatriptan blood levels 1

Orally Disintegrating Tablets (Maxalt MLT):

• Available for patients with significant nausea or vomiting 3
• Same dosing as standard tablets (5 mg or 10 mg) 3

Treatment Trial Period

Before determining effectiveness:

• Try rizatriptan for 2-3 migraine episodes before concluding it is ineffective 3
• If rizatriptan fails after adequate trial, consider switching to a different triptan, as failure of one does not predict failure of others 3

Critical Safety Limitations

Absolute Contraindications:

• Concurrent use with ergotamine derivatives or within 24 hours of another triptan 3
• Hemiplegic or basilar migraine 3
• Coronary artery disease or previous myocardial infarction 3
• Uncontrolled hypertension 3
• Current MAOI use 3
• Impaired hepatic function 3

Frequency Restriction:

• Never exceed 4 headache treatments per 30-day period on average, as safety beyond this has not been established 1
• Using acute medications more than twice weekly can lead to medication-overuse headache, creating a vicious cycle of increasing headache frequency 3

Common Adverse Effects

Expected side effects (typically mild and transient):

• Chest pressure and heaviness 3
• Throat tightness 3
• Dizziness, somnolence, and asthenia/fatigue 4, 5
• These effects usually last 2-3 hours and occur in less than 10% of patients 2

Comparative Efficacy

Rizatriptan 10 mg demonstrates superior efficacy compared to other triptans:

• More effective than zolmitriptan 2.5 mg or naratriptan 2.5 mg at producing pain-free state at 2 hours 4, 5
• Provides faster pain relief than oral sumatriptan with greater reduction in nausea 4, 5
• Up to 77% of patients achieve pain relief at 2 hours with the 10 mg dose 2

When to Escalate or Change Therapy

If rizatriptan is inadequate after proper trial:

• Consider combination therapy with an NSAID (naproxen 500 mg) for enhanced efficacy 6
• Switch to a different triptan if rizatriptan fails after 2-3 episodes 3
• Initiate preventive therapy if requiring acute treatment more than twice weekly 6