Selective 5-HT1B/1D agonist (triptan)
Rizatriptan
Brand names: Maxalt, Maxalt Melt
Adult dose
Dose: 10mg PO at onset, may repeat after 2h (max 20mg/24h). Patients on propranolol: 5mg dose
Route: PO (incl. ODT)
Frequency: PRN
Clinical pearls
- Acute migraine; ODT useful with nausea
- NICE CG150 — first-line acute treatment with NSAID/paracetamol
Contraindications
- Ischaemic heart disease
- Cerebrovascular disease
- Severe hepatic/renal impairment
- Uncontrolled hypertension
- MAOI within 14 days
- Concurrent ergotamine/triptans
Side effects
- Chest tightness
- Paraesthesia
- Dizziness
- Drowsiness
- Serotonin syndrome (with SSRIs/SNRIs — rare)
- Coronary vasospasm
Interactions
- MAOIs
- Other triptans/ergot
- SSRIs/SNRIs
- Propranolol (raises levels)
Monitoring
- Symptoms
- BP
Reference: BNF; NICE CG150; https://bnf.nice.org.uk/drugs/rizatriptan/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Pathways
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS