Rizatriptan Dosing for Pediatric Migraine
Weight-Based Dosing Regimen
For pediatric patients aged 6-17 years, rizatriptan should be dosed at 5 mg for children weighing less than 40 kg (88 lb) and 10 mg for those weighing 40 kg (88 lb) or more. 1
Specific Dosing by Weight Category
- Children <40 kg (88 lb): Administer rizatriptan 5 mg orally disintegrating tablet (ODT) 1
- Children ≥40 kg (88 lb): Administer rizatriptan 10 mg orally disintegrating tablet (ODT) 1
Maximum Daily Limits
- Only one dose is permitted within any 24-hour period in pediatric patients aged 6-17 years 1
- The efficacy and safety of treating with more than one dose within 24 hours has not been established in this age group 1
- In adults, the maximum daily dose is 30 mg in 24 hours, but this multi-dose approach has not been validated for pediatric use 1
Special Considerations for Propranolol Use
Critical drug interaction requiring dose adjustment:
- Adolescents ≥40 kg on propranolol: Use only a single 5 mg dose (maximum 5 mg in 24 hours) 1
- Children <40 kg on propranolol: Rizatriptan should NOT be prescribed to this population 1
- This restriction is due to significant pharmacokinetic interactions that increase rizatriptan exposure 1
Clinical Context and Treatment Algorithm
When to Use Rizatriptan
- First-line treatment remains ibuprofen 10 mg/kg for all pediatric migraine patients 2
- Consider rizatriptan when: NSAIDs have failed, migraine presents with moderate-to-severe intensity, rapid escalation of headache occurs, or significant nausea/vomiting is present 2
- Rizatriptan is particularly useful for rapidly escalating attacks where non-oral formulations may be preferred 2
Evidence Supporting This Dosing
The weight-based dosing scheme (5 mg for <40 kg, 10 mg for ≥40 kg) generates plasma concentrations similar to the proven effective 10 mg adult dose 3. In clinical trials, this dosing achieved pain freedom at 2 hours in 30.6% of adolescents (12-17 years) compared to 22.0% with placebo 4. A separate crossover trial demonstrated even higher efficacy, with 73-74% achieving headache relief at 2 hours versus 36% with placebo 5.
Safety Profile
Long-term safety data from 606 pediatric patients treating an average of 20 migraine attacks showed that 66% experienced any adverse event within 14 days post-dose, but only 2.3% discontinued due to adverse events and 2.6% had serious adverse events (only 3 of which were drug-related, all involving overdose) 6. The medication was generally well tolerated with consistent efficacy over 12 months of use 6.
Important Contraindications
- Do not use in patients with: cardiovascular disease, uncontrolled hypertension, or hemiplegic migraine 2
- Avoid medication overuse: Do not exceed 10 days per month of triptan use to prevent medication overuse headache 2