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Rizatriptan benzoate
Rizatriptan benzoate (Maxalt, Maxalt-MLT)
Rizatriptan benzoate
(rise-ah-TRIP-tan)
Pregnancy Category: C Maxalt Maxalt-MLT (Rx)

Classification: Antimigraine drug

Action/Kinetics: Binds to 5-HT_IB/ID receptors, resulting in cranial vessel vasocontriction, inhibition of neuropeptide release, and reduced transmission in trigeminal pain pathways. Completely absorbed after PO use; rate of absorption of Maxalt-MLT is somewhat slower. Peak plasma levels, Maxalt: 1-1.5 hr; Maxalt-MLT: 1.6-2.5 hr. Food has no effect on bioavailability, but will delay time to reach peak levels by an hr. t1/2: 2-3 hr. Metabolized by MAO-A; most is excreted through the urine. Is a significant first-pass effect.

Uses: Acute treatment of migraine attacks in adults with or without aura.

Contraindications: Use in children less than 18 years of age, as prophylactic therapy of migraine, or use in the management of hemiplegic or basilar migraine. Use in those with ischemic heart disease or vasospastic coronary artery disease, uncontrolled hypertension, within 24 hr of treatment with another 5-HT₁ agonist or an ergotamine-containing or ergot-type medication (e.g., dihydroergotamine, methysergide). Use concurrently with MAO inhibitors or use of rizatriptan within 2 weeks of discontinuing a MAO inhibitor. Strongly recommended the drug not be given in unrecognized coronary artery disease (CAD) predicted by the presence of risk factors, including hypertension, hypercholesterolemia, smoking, obesity, diabetes, strong family history of CAD, female with surgical or physiological menopause, or males over 40, unless a CV evaluation reveals the client is free from CAD or ischemic myocardial disease.

Special Concerns: Safety and efficacy have not been determined for use in cluster headache or in children. Use with caution during lactation, with diseases that may alter the absorption, metabolism, or excretion of drugs; in dialysis clients, and in moderate hepatic insufficiency. Maxalt-MLT tablets contain phenylalanine; may be of concern to phenylketonurics.

Side Effects: CV: Acute MI, coronary artery vasospasm, life-threatening disturbances in cardiac rhythm (VT, ventricular fibrillation), death, cerebral hemorrhage, subarachnoid hemorrhage, stroke, hypertensive crisis. Also, transient myocardial ischemia, peripheral vascular ischemia, colonic ischemia with abdominal pain and bloody diarrhea, palpitation, tachycardia, cold extremities, hypertension, arrhythmia, bradycardia. GI: Nausea, dry mouth, abdominal distention, vomiting, dyspepsia, thirst, acid regurgitation, dysphagia, constipation, flatulence, tongue edema. CNS: Somnolence, headache, dizziness, paresthesias, hypesthesia, decreased mental acuity, euphoria, tremor, nervousness, vertigo, insomnia, anxiety, depression, disorientation, ataxia, dysarthria, confusion, dream abnormality, abnormal gait, irritability, impaired memory, agitation, hyperesthesia. Pain and pressure sensations: Chest tightness/pressure and/or heaviness; pain/tightness/pressure in the precordium, neck, throat, jaw; regional pain, tightness, pressure, or heaviness; or unspecified pain. Musculoskeletal: Muscle weakness, stiffness, myalgia, muscle cramps, musculoskeletal pain, arthralgia, muscle spasm. Respiratory: Dyspnea, pharyngitis, nasal irritation, nasal congestion, dry throat, URI, yawning, dry nose, epistaxis, sinus disorder. GU: Urinary frequency, polyuria, menstrual disorder. Dermatologic: Flushing, sweating, pruritus, rash, urticaria. Body as a whole: Asthenia, fatigue, chills, heat sensitivity, hangover effect, warm/cold sensations, dehydration, hot flashes. Ophthalmic: Blurred vision, dry eyes, burning eye, eye pain, eye irritation, tearing. Miscellaneous: Facial edema, tinnitus, ear pain.

Drug Interactions: Dihydroergotamine / Additive vasospastic reactions; do not use within 24 hr of each other MAO Inhibitors / Rizatriptan plasma levels; do not use together Methysergide / Additive vasospastic reactions; do not use within 24 hr of each other Propranolol / Rizatriptan plasma levels

How Supplied: Orally Disintegrating Tablets: 5 mg, 10 mg; Tablets: 5 mg, 10 mg.

Dosage
•Oral Disintegrating Tablets, Tablets Acute treatment of migraine.
Adults: Single dose of 5 mg or 10 mg of Maxalt or Maxalt-MLT. Doses should be separated by at least 2 hr, with no more than 30 mg taken in any 24-hr period.