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(rye-zah-TRIP-tan)

Maxalt

Tablets: 5 mg, 10 mg

Maxalt-MLT

Tablets, orally disintegrating: 5 mg, 10 mg

Class: Analgesic, Migraine

 Action Binds to serotonin 1_B and 1_D receptors in intracranial arteries leading to vasoconstriction and subsequent relief of migraine headache.

 Indications Treatment of acute migraine attacks with or without aura.

 Contraindications Patients with ischemic heart disease (eg, angina, MI history, silent ischemia, coronary artery vasospastic disease, uncontrolled hypertension, basal or hemiplegic migraine). Rizatriptan is contraindicated within 24 hr of use with other serotonin agonists, ergotamine compounds, or methysergide, or concurrent treatment with MAOIs or within 14 days following discontinuation of an MAOI.

 Route/Dosage

ADULTS: PO 5 or 10 mg tablet with the onset of migraine headache. Individualize dose based on response and side effects. Doses may be repeated after a min of 2 hr as needed with a max dose of 30 mg in a 24-hr period. Patients taking propanolol should receive the 5 mg dose with a max of 3 doses (15 mg) in a 24-hr period. The MLT formulation is a rapidly disintegrating tablet that may be taken without water. It is placed on the tongue where it rapidly breaks apart and can then be swallowed with normal saliva production.

 Interactions

5-HT₁ Agonists (eg, Sumatriptan)

Increased risk of vasospastic reations; therefore, coadministration of two 5-HT₁ agonists within 24 hr of each other is contraindicated.

Ergot-Containing Drugs

Additive and prolonged vasospasm.

MAOIs

Use of rizatriptan with MAOIs or within 14 days following discontinuation of an MAOI is contraindicated.

Propanolol

Increased rizatriptan plasma concentrations.

Selective Serotonin Reuptake Inhibitors (Citalopram, Fluoxetine, Fluvoxamine, Sertraline)

Weakness, hyperreflexia, and incoordination have been rarely reported.

Sibutramine

Serotonin syndrome, including CNS irritability, motor weakness, shivering, myoclonus, and altered consciousness may occur.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Coronary spasm; transient myocardial ischemia; MI; ventricular arrhythmias; palpitations; tachycardia; bradycardia; other arrhythmias; cold extremities; hypertension. CNS: Dizziness; headache; somnolence; hypesthesia; decreased mental acuity; euphoria; tremor; nervousness; vertigo; insomnia; anxiety; depression; disorientation; ataxia; confusion. EENT: Blurred vision; tinnitus; dry eyes; burning, painful, or irritated eyes; tearing. GI: Dry mouth; nausea; diarrhea; vomiting; dyspepsia; thirst; acid reflux; dysphagia; constipation; flatulence; swollen tongue. RESPIRATORY: Dyspnea. OTHER: Warm or cold sensations; flushing; sweating; pruritus; paresthesia; pressure; tightness; heaviness sensations; muscle weakness; stiffness; myalgia; arthralgia; cramps.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy in children < 18 yr not established. Cardiac: May cause coronary vasospasm in patients with coronary artery disease. Administer first dose in physician’s office or similarly staffed and equipped facility to patients at possible risk of unrecognized coronary disease. Renal or Hepatic Impairment: Clearance is decreased; use with caution. Phenylketoneurics: The MLT formulation contains phenylalanine.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

• Administer PO in single dose with adequate amounts of fluids.
• Administer the MLT formulation without water; dissolve on tongue and swallow with saliva.
• Do not administer to patient with documented ischemic or vasospastic coronary artery disease.
• Store at room temperature; protect from light and moisture.

 Assessment/Interventions

• Obtain patient history, including drug history, and any known allergies.
• Assess symptoms of migraine attacks, including pain location, intensity, duration, photophobia, and phonophobia.
• Assess for presence of risk factors such as hypertension, hypercholesterolemia, smoking, obesity, diabetes, and strong family history of coronary artery disease.
• Review history and laboratory tests for signs of decreased hepatic and renal function. Dosage needs to be adjusted with mild to moderate hepatic or renal impairment and contraindicated with severe impairment.
• If risk factors are present, administer first dose in a medically staffed and equipped facility as ischemia can occur in the absence of clinical symptoms.
• Hold medication and notify health care provider if during the cardiovascular evaluation, electrocardiogram or laboratory results reveal findings of coronary artery vasospasm or myocardial ischemia.
• If ergot-containing medications have been used, wait 24 hr following their discontinuation before administration of rizatriptan.
• Monitor BP prior to and after initial dose. If angina occurs, monitor for ischemic changes and take appropriate actions if present.
• Provide a quiet, dark environment.
• Assess for relief or lowering of symptoms such as migraine-associated nausea, photophobia, and phonophobia.
• If overdose occurs, monitoring of patients should continue for ³ 24 hr or while symptoms or signs persist.

OVERDOSAGE: SIGNS & SYMPTOMS   Hypertension

 Patient/Family Education

• Provide patient information pamphlet.
• Explain that the drug is to be used during migraine attack and does not reduce or prevent the number of attacks.
• Caution the patient that if headache returns, the dose may be repeated only once after 4 hr for a max dose of 5 mg in 24 hr. If overdose is taken, contact a hospital emergency department or nearest poison control center immediately.
• Instruct patient to notify health care provider immediately if sudden or severe abdominal pain, shortness of breath, wheeziness, heart throbbing, swelling of eyelids, face, or lips, skin rash, skin lumps, or hives occur.
• Instruct patient to report symptoms of tingling, heat, flushing (eg, redness of face lasting a short time), heaviness or pressure, drowsiness, dizziness, tiredness, or sickness.
• Instruct patient to notify health care provider if feeling unwell or having any confusing symptoms.
• Instruct patient concerning storage of medication.
• Instruct patient taking the MLT formulation to not remove the blister from the outer aluminum pouch until ready to use if tablets are separately packaged.
• Instruct women to notify health care provider if pregnant, might be pregnant, trying to become pregnant, or not using adequate contraception.
• Inform patient that drug or migraines may cause drowsiness or dizziness and to use caution while driving or performing tasks that require mental alertness.

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