Home Drug Guide Rizatriptan Benzoate

Drug Guide

Generic Name

Rizatriptan Benzoate

Brand Names Maxalt, Maxalt-mlt, Rizafilm

Classification

Therapeutic: Antimigraine agent

Pharmacological: Selective 5-HT1B/1D receptor agonist (triptan)

FDA Approved Indications

  • Acute treatment of migraine attacks with or without aura

Mechanism of Action

Rizatriptan selectively binds to serotonin 5-HT1B and 5-HT1D receptors, leading to vasoconstriction of intracranial blood vessels, inhibition of neuropeptide release, and diminution of transmission in pain pathways within the central nervous system.

Dosage and Administration

Adult: Initial dose typically 5 mg orally; can repeat after 2 hours if needed, not exceeding 30 mg in 24 hours.

Pediatric: Not recommended for children under 6 years. For ages 6-17, dosing should be guided by a healthcare provider.

Geriatric: Use with caution; start at the lower end of dosing range due to potential increased sensitivity.

Renal Impairment: Adjust dose based on severity; use caution.

Hepatic Impairment: Use with caution; start at lower doses due to increased systemic exposure.

Pharmacokinetics

Absorption: Rapidly absorbed after oral administration with peak plasma levels in approximately 1-1.5 hours.

Distribution: Widely distributed with a volume of distribution of about 2-4 L/kg.

Metabolism: Extensively metabolized by monoamine oxidase-A (MAO-A) with minimal cytochrome P450 involvement.

Excretion: Primarily eliminated via renal route; metabolites are excreted in urine.

Half Life: Approximately 2-3 hours.

Contraindications

  • History of ischemic cardiac disease, coronary artery vasospasm or angina pectoris
  • History of cerebrovascular accident or transient ischemic attack
  • Uncontrolled hypertension
  • Ischemic bowel disease

Precautions

  • Use with caution in patients with risk factors for cardiovascular disease, including hypertension, hyperlipidemia, smoking, or family history of cardiac disease.
  • Potential for cardiac ischemia; consider cardiac evaluation if indicated.

Adverse Reactions - Common

  • Dizziness (Common)
  • Drowsiness (Common)
  • Throat/neck heaviness or pressure (Common)

Adverse Reactions - Serious

  • Myocardial infarction (Rare)
  • Serotonin syndrome (when combined with other serotonergic drugs) (Rare)
  • Allergic reactions including angioedema, rash (Rare)

Drug-Drug Interactions

  • Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), MAO inhibitors (MAOIs). Use together may increase risk of serotonin syndrome.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Assess for cardiovascular disease history before administering.

Diagnoses:

  • Risk for ineffective cerebral/cardiac tissue perfusion.
  • Imbalanced nutrition: less than body requirements.

Implementation: Administer at onset of migraine symptoms. Monitor blood pressure and for cardiac symptoms.

Evaluation: Assess effectiveness by reduction in migraine severity and duration.

Patient/Family Teaching

  • Take at first sign of migraine.
  • Do not exceed recommended dose.
  • Report chest pain, tightness, dizziness, or signs of allergic reaction immediately.
  • Avoid concomitant use with other serotonergic agents unless instructed by a healthcare provider.

Special Considerations

Black Box Warnings:

  • Cardiovascular risk: contraindicated in patients with ischemic heart disease or uncontrolled hypertension.

Genetic Factors: Genetic variations in CYP1A2 enzyme may affect metabolism.

Lab Test Interference: May affect some cardiac enzyme tests due to vasoconstrictive properties.

Overdose Management

Signs/Symptoms: Signs may include dizziness, tightness in chest, vomiting, altered consciousness.

Treatment: Supportive care, activated charcoal if ingestion was recent, and cardiovascular monitoring.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable for 24 months when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.