How frequently may an adult take rizatriptan (Maxalt) on an as‑needed basis for migraine attacks?

How Often Can Someone Take PRN Rizatriptan for Migraine

Rizatriptan can be taken every 2 hours as needed for migraine recurrence, with a maximum of 30 mg (three 10-mg doses) in any 24-hour period. 1

Standard Dosing Frequency

• The FDA-approved dosing allows a second dose 2 hours after the first dose if the migraine returns, with the critical limitation being no more than 30 mg total in 24 hours 1
• For patients on propranolol, use only 5-mg doses with a maximum of 15 mg (three doses) in 24 hours 1
• The American Academy of Family Physicians supports this every-2-hour dosing interval when headache recurs 2

Maximum Monthly Use to Prevent Medication Overuse Headache

A critical pitfall is overuse leading to medication overuse headache—limit rizatriptan to no more than 10 days per month. 2 This threshold is lower than for NSAIDs and must be monitored carefully to avoid transforming episodic migraine into chronic daily headache.

Optimal Treatment Strategy

• Take rizatriptan early when headache is still mild for maximum effectiveness—do not wait until pain becomes severe 3
• Trial rizatriptan for 2-3 separate migraine episodes before abandoning it, as response can vary between attacks 4, 2, 3
• If one triptan fails after adequate trial, switch to a different triptan (such as sumatriptan, eletriptan, or naratriptan), as individual patients respond differently to different triptans 4, 2

When Single-Dose Rizatriptan Is Insufficient

If rizatriptan alone provides inadequate relief, add an NSAID (naproxen, ibuprofen, or diclofenac) rather than increasing triptan frequency. 3 Combination therapy with triptan plus NSAID is more effective than either agent alone or increasing the triptan dose.

Formulation Selection Based on Symptoms

• Use orally disintegrating tablets (Maxalt MLT) when nausea or vomiting are present, as they do not require water and may be better tolerated 4, 2, 3
• Standard tablets are appropriate when gastrointestinal symptoms are minimal 1

Contraindications That Preclude Use

Rizatriptan is absolutely contraindicated in patients with:

• Coronary artery disease, vasospastic conditions, or uncontrolled hypertension 4, 3
• Hemiplegic or basilar migraine 2, 3
• Concurrent use with ergotamine derivatives or within 24 hours of another triptan 4, 2, 3
• Current MAOI use or within 2 weeks of discontinuation 3
• Pregnancy 2, 3

Pediatric Dosing (Ages 6-17 Years)

• For children weighing <40 kg (88 lb): 5 mg single dose 1
• For children weighing ≥40 kg (88 lb): 10 mg single dose 1
• The safety of multiple doses within 24 hours has not been established in pediatric patients 1

Common Adverse Effects to Counsel Patients About

• Chest pressure, heaviness, or throat tightness occur commonly but are typically transient (2-3 hours) and mild to moderate 2, 5
• Dizziness, somnolence, and fatigue are dose-related 6