Can Frovatriptan and Rizatriptan Be Taken Together for Migraines?
No, frovatriptan (Frova) and rizatriptan should not be taken together on the same day for migraine treatment. 1
Critical Safety Concern: Triptan Spacing Requirements
Triptans should never be combined or taken within 24 hours of each other due to the risk of additive vasoconstrictive effects and potential cardiovascular complications. 1, 2
Both frovatriptan and rizatriptan are serotonin 5-HT₁B/1D receptor agonists that work through the same mechanism—causing vasoconstriction of intracranial blood vessels. 3, 4
Taking two triptans together or in close succession increases the risk of coronary vasospasm, myocardial ischemia, and other serious cardiovascular events. 5
Appropriate Use of Multiple Triptans
If one triptan fails for a particular attack, you may try a different triptan for the next migraine attack (not the same attack), as failure of one triptan does not predict failure of others. 2
For the current migraine attack, if the first triptan dose is ineffective after 2 hours, you may take a second dose of the same triptan (not a different one), respecting maximum daily dosing limits. 5
Rizatriptan maximum: 30 mg per 24 hours (three 10-mg doses or six 5-mg doses). 4, 6
Frovatriptan maximum: 7.5 mg per 24 hours (three 2.5-mg doses). 3
Alternative Strategies When Initial Triptan Fails
Add an NSAID to the triptan rather than switching to a different triptan—combination therapy with a triptan plus NSAID (naproxen 500 mg or ibuprofen 400-800 mg) provides superior efficacy compared to either agent alone. 2, 7, 5
Consider adding acetaminophen 1000 mg to the triptan, which also shows directionally favorable effects compared to triptan monotherapy. 7
Use an antiemetic (metoclopramide 10 mg or prochlorperazine 10 mg) for synergistic analgesia and nausea relief. 2
Medication-Overuse Headache Prevention
Limit all acute migraine medications to no more than 2 days per week to prevent medication-overuse headache, which paradoxically increases headache frequency. 1, 2, 7
If needing acute treatment more than twice weekly, preventive therapy should be initiated immediately with agents like erenumab, fremanezumab, galcanezumab, topiramate, or propranolol. 1, 8
Choosing Between Frovatriptan and Rizatriptan for Future Attacks
Rizatriptan 10 mg provides faster pain relief (peak concentration at 2.3 hours, terminal half-life 3.2 hours) and higher rates of pain freedom at 2 hours compared to frovatriptan. 9, 4
Frovatriptan 2.5 mg has a longer duration of action (terminal half-life 29.3 hours) and significantly lower recurrence rates within 72 hours, making it preferable for patients with frequent headache recurrence. 3, 9
Frovatriptan is better tolerated with fewer adverse events (one versus eight adverse events in head-to-head comparison). 9
For moderate-to-severe attacks requiring rapid relief, rizatriptan is more appropriate; for attacks with high recurrence rates or when tolerability is a concern, frovatriptan is preferable. 3, 9, 5