Selective 5-HT1B/1D agonist (triptan) Pregnancy: A moderate amount of data on pregnant women (300–1000 pregnancy outcomes) indicates no malformative toxicity after first-trimester exposure; data in the second and third trimesters are limited. Use may be considered during pregnancy if clinically necessary. Breast-feeding: excreted in low concentration in human milk (average relative infant dose <1%) — exercise caution; infant exposure may be minimised by avoiding breast-feeding for 12 hours after treatment.

Rizatriptan

Brand names: Maxalt, Maxalt Melt

Used in: Headache & Migraine

Rizatriptan is a triptan (5-HT1B/1D receptor agonist) used for the acute treatment of migraine attacks. It is not used for migraine prevention.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 10 mg as a single dose for an acute migraine attack (adults 18 years of age and older)

Route: Oral — orodispersible tablet placed on the tongue, where it dissolves and is swallowed with saliva; need not be taken with liquid

Frequency: As needed for an acute attack; doses must be separated by at least 2 hours

Max: No more than 2 doses in any 24-hour period, separated by at least 2 hours

Rizatriptan should NOT be used prophylactically. Headache recurrence within 24 hours: if headache returns after relief of the initial attack, one further dose may be taken within the above limits. Non-response: if a patient does not respond to the first dose, a second dose should NOT be taken for the same attack (efficacy of a second dose after an ineffective first dose has not been examined in controlled trials); patients who do not respond to one attack are still likely to respond to subsequent attacks. The lower 5 mg dose should be used in: patients on propranolol (separate rizatriptan and propranolol administration by at least 2 hours), patients with mild or moderate renal insufficiency, and patients with mild to moderate hepatic insufficiency — same limits apply (at least 2 hours apart, maximum 2 doses in 24 hours). Do not remove the orodispersible tablet from the blister until just prior to dosing, and handle with dry hands. Timing with ergot medicines: wait at least 6 hours after rizatriptan before giving an ergotamine-type medicine, and at least 24 hours after an ergotamine-containing preparation before giving rizatriptan. Paediatric: safety and efficacy in children and adolescents under 18 years has not been established and no recommendation on a posology can be made. Patients older than 65 years: safety and effectiveness have not been systematically evaluated.

Dose adjustments

Renal

Use the lower 5 mg dose in patients with mild or moderate renal insufficiency. Contraindicated in severe renal insufficiency.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Although rizatriptan benzoate 5 mg tablets and orally disintegrating tablets are available in the marketplace, MAXALT Tablets and MAXALT-MLT Orally Disintegrating Tablets are no longer marketed in the 5 mg strength. Adults: 5 or 10 mg single dose; separate repeat doses by at least two hours; maximum dose in a 24-hour period: 30 mg ( 2.1 ) Pediatric patients 6 to 17 years: 5 mg single dose in patients less than 40 kg (88 lb); 10 mg single dose in patients 40 kg (88 lb) or more ( 2.2 ) Adjust dose if co-administered with propranolol ( 2.4 ) 2.1 Dosing Information in Adults The recommended starting dose of rizatriptan benzoate is either 5 mg or 10 mg for the acute treatment of migraines in …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2026-01-29. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to rizatriptan or to any of the excipients
Concurrent administration of monoamine oxidase (MAO) inhibitors, or use within two weeks of discontinuing MAO inhibitor therapy
Severe hepatic or severe renal insufficiency
Previous cerebrovascular accident (CVA) or transient ischaemic attack (TIA)
Moderately severe or severe hypertension, or untreated mild hypertension
Established coronary artery disease — including ischaemic heart disease (angina pectoris, history of myocardial infarction, or documented silent ischaemia), signs and symptoms of ischaemic heart disease, or Prinzmetal's angina
Peripheral vascular disease
Concomitant use with ergotamine, ergot derivatives (including methysergide), or other 5-HT1B/1D receptor agonists

Side effects

Dizziness, somnolence and asthenia/fatigue (the most common effects in clinical studies)
Paraesthesia, hypoaesthesia, headache and decreased mental acuity (common)
Nausea, dry mouth, vomiting, diarrhoea and dyspepsia (common)
Palpitation (common); arrhythmia, ECG abnormalities and tachycardia (uncommon); myocardial ischaemia or infarction (not known, mostly in patients with risk factors for coronary artery disease)
Regional heaviness, neck pain and stiffness, and pain in abdomen or chest (common) — chest/throat tightness may be intense and requires evaluation if ischaemic heart disease is suspected

Interactions

MAO inhibitors — contraindicated concurrently or within two weeks of discontinuation (§4.3)
Ergotamine, ergot derivatives (including dihydroergotamine and methysergide) — concomitant use contraindicated; wait at least 6 hours after rizatriptan before an ergotamine-type medicine and at least 24 hours after an ergotamine preparation before rizatriptan
Other 5-HT1B/1D receptor agonists (e.g. sumatriptan) — concomitant use contraindicated
Propranolol — use the lower 5 mg rizatriptan dose and separate administration by at least 2 hours (propranolol increases rizatriptan plasma AUC by 70%)
SSRIs and SNRIs — serotonin syndrome (altered mental status, autonomic instability, neuromuscular abnormalities) has been reported with triptans; if concomitant treatment is clinically warranted, observe the patient closely, particularly at initiation, on dose increase, or when another serotonergic medicine is added

Clinical monograph

How it works

It stimulates 5-HT1B/1D receptors, causing constriction of dilated cranial blood vessels and inhibiting the release of pro-inflammatory neuropeptides involved in migraine.

Prescribing in practice

It is contraindicated in ischaemic heart disease, previous myocardial infarction, coronary vasospasm, cerebrovascular disease and uncontrolled hypertension because it causes vasoconstriction.
Overuse can cause medication-overuse headache, so limit the frequency of treatment days and review patients who use it often.
It interacts with propranolol, which raises rizatriptan levels (a lower triptan dose may be needed), and with other serotonergic drugs, increasing the risk of serotonin toxicity.

Monitoring

Assess cardiovascular risk before first use; review attack frequency and the number of treatment days to detect medication overuse, and check for interacting serotonergic medicines.

Counselling the patient

Use it to treat an attack, not to prevent migraines, and avoid using acute treatment on too many days each week to prevent rebound headaches.
Report chest tightness, chest pain or throat tightness.
Tell your prescriber about all other medicines, especially propranolol and antidepressants.

Evidence & guidelines

Licensed and guideline-recommended for acute migraine (NICE NG217 / CKS Migraine).

Reference: NICE CG150; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

MIDAS (Migraine Disability Assessment) · Headache

Pathways