Rizatriptan: Usage, Dosage, Side Effects & More

Migraines impact one in every six adults in the U.S. For some people, over-the-counter (OTC) painkillers alone may take the edge off of a headache.

Others, however, may have severe migraines that don’t respond to OTC painkillers alone—or they may get migraines frequently.

These people may benefit from a prescription migraine medication. 

Rizatriptan, sold under the brand names Maxalt or Maxalt-Mlt, is a prescription medication that can treat migraine headaches.

While rizatriptan can improve migraine symptoms, it can cause side effects.

Additionally, people with certain risk factors should avoid taking rizatriptan.

Your healthcare provider can help you determine the best migraine medication for you. 

In this article, I’ll talk about rizatriptan dosage, how fast it works, and the medication’s side effects.

I’ll cover interactions other drugs may have with rizatriptan, and list some precautions to be aware of before taking rizatriptan.

Finally, I’ll cover rizatriptan treatment alternatives and when to see a doctor.

Rizatriptan Dosage

Rizatriptan is a type of medication known as a triptan.

It acts as a selective serotonin receptor agonist, meaning it activates serotonin receptors in the brain.

Rizatriptan treats migraine symptoms by narrowing blood vessels in the brain, stopping pain signals from being sent to the brain, and blocking the release of chemicals that can lead to migraine pain and nausea. 

Rizatriptan is an acute migraine treatment. It’s effective after you already have symptoms of a migraine, but won’t prevent a migraine attack from occurring. 

This drug comes as a regular tablet and an orally disintegrating tablet (which can be useful if you have nausea or vomiting with your migraine).

It’s available in 5 or 10 mg as a single dose.

The dosage a doctor prescribes depends on several factors, including the severity of your migraines.

Always follow your doctor’s instructions for rizatriptan dosage.

Common dosages of rizatriptan include: 

• Adults: Take 5 or 10 mg at a time. If your migraine remains or goes away and comes back, you can take another dose two hours after the last. No more than 30 mg of rizatriptan should be taken within a 24-hour timeframe. 

• Children and teenagers older than six and weighing at least 88 pounds (40 kg): A healthcare provider should recommend the appropriate dose for children and teenagers based on body weight, but it’s typically 10 mg per day maximum. Avoid taking more than one dose in a 24-hour timeframe. 

• Children and teenagers older than six and weighing less than 88 pounds (40 kg): The dose depends on body weight and should be determined by a healthcare provider, but it’s typically 5 mg per day maximum. Avoid taking more than one dose in a 24-hour timeframe. 

• Children younger than six years old: A doctor should determine if it’s safe for a child to use rizatriptan and prescribe the appropriate dosage. 

How to use rizatriptan

Rizatriptan is most effective if you take it as soon as you notice symptoms of a migraine.

It’s best to wait until the headache pain begins, even if you get a migraine aura beforehand. 

How you take rizatriptan depends on the type of tablet you’re using.

Swallow a rizatriptan tablet whole, rather than crushing it or chewing it. 

If you have orally disintegrating tablets, called Maxalt-Mlt, place one under your tongue and allow it to fully dissolve. You don’t need a drink to swallow it. 

You can eat normally after taking rizatriptan; there’s no need to follow a special diet.

Lying down in a dark and quiet room may help improve your symptoms after you take rizatriptan.

Always follow your doctor’s instructions for taking rizatriptan, and carefully read the instructions on the medication label.

Never change your dosage unless your healthcare provider advises you to. 

How Fast Does Rizatriptan Work?

Studies suggest rizatriptan can relieve headache pain associated with a migraine within 30 minutes.

For some people, it may take longer.

If you still have a headache after two hours, you can repeat the dose.

Don’t take more than 30 mg of rizatriptan within any 24-hour period. 

Rizatriptan Side Effects

Rizatriptan, like many other drugs, can cause unwanted side effects.

Some side effects are common and not medically concerning, while others are serious and warrant medical care.

Some common rizatriptan side effects include: 

• Sleepiness
• Dizziness
• Dry mouth
• Pain or pressure in your chest and/or throat
• Headache (not a migraine)
• Nausea
• A tingling sensation 
• Hot flashes

Other side effects are more rare. These include: 

• Agitation or anxiety 
• Digestive symptoms, such as constipation or diarrhea 
• Increased sweating
• Depression 
• Difficulty swallowing 
• Heartburn 
• Difficulty sleeping 
• Muscle pain or spasms
• Heat sensitivity
• Chills
• Ringing in the ears
• Eye irritation 
• Itchy skin
• Muscle or joint tightness or stiffness
• Gas
• Tremors
• Blurred vision
• Confusion
• Increased urine output

If you experience any of the following serious side effects, contact a healthcare provider, call 9-1-1, or go to the emergency department right away: 

• Heart attack: Pain or tightness in your chest, nausea or vomiting, shortness of breath, feeling like you might pass out, cold sweats

• Stroke: Numbness on one side of your body, weakness, dizziness, confusion, loss of balance, difficulty speaking

• Serotonin syndrome: Fast heartbeat, nausea and/or vomiting, agitation, hallucination, elevated body temperature, rigid muscles

In many cases, less serious side effects of rizatriptan improve over time.

If your side effects are bothersome or persistent, or if you experience new side effects, speak with your healthcare provider.

Your doctor can either adjust the dose of rizatriptan or recommend another medication to treat your migraines. 

What happens when you overdose

Taking too much of any medication can be dangerous.

Always follow your doctor’s instructions and the product label when you take rizatriptan to avoid an overdose.

Using too much rizatriptan may increase your risk of experiencing unwanted side effects.

Excessive rizatriptan can also cause serotonin syndrome, a potentially fatal condition caused by excessive amounts of serotonin in the body. 

The following signs may indicate a rizatriptan overdose: 

• Excessive drowsiness
• Faintness 
• Rapid or irregular heartbeat 
• Vomiting
• Shortness of breath 
• Heaviness or pain in the chest, throat, neck, or jaw

If you think you may have taken too much rizatriptan or have overdosed, call 9-1-1 or go to an emergency department immediately. 

What happens when you miss a dose

Rizatriptan is a drug you should only take as needed to improve migraine symptoms.

Do not take it every day to prevent migraine headaches. 

Take rizatriptan as soon as you notice a migraine headache, and repeat as needed every two hours if your headache doesn’t go away or gets worse.

Don’t exceed 30 mg of rizatriptan in one 24-hour period unless advised otherwise by a healthcare provider. 

Drug Interactions with Rizatriptan

Tell your doctor or healthcare provider if you take any other medications, even over-the-counter drugs or vitamins and supplements.

Some drugs may interact negatively with rizatriptan, reducing the effectiveness of the medication or increasing the chances of side effects.

Your healthcare provider or pharmacist can tell you all the drugs that could interact with rizatriptan, but here are some of the most common: 

• Monoamine oxidase inhibitors (MAOIs): These drugs, often used to treat depression, can cause a serious drug interaction. Avoid taking MAOIs, such as isocarboxazid, with rizatriptan.
  
• Other drugs that increase serotonin: Your risk of serotonin syndrome increases if you take other medications that increase this brain chemical. Selective serotonin reuptake inhibitors (SSRIs), such as Zoloft, Prozac, and Lexapro, are common medications that can increase the risk of serotonin syndrome when combined with rizatriptan. Other medications that may increase the risk of serotonin syndrome when taken with rizatriptan include St. John’s Wort and other migraine drugs, including other triptans and ergotamines.
  
• Propranolol: This drug, which often treats hypertension and anxiety, may cause an increased risk of side effects by increasing the amount of rizatriptan in your body. Your doctor can help you determine whether it’s safe or beneficial for you to take both of these medications. 

What to avoid when taking rizatriptan

Rizatriptan can cause drowsiness and dizziness.

It may be best to avoid driving or any other risky activities after you take it, especially if you feel tired, lightheaded, or dizzy.

Don’t take any other serotonin-increasing drugs, especially illicit drugs like MDMA or ecstasy, when you’re taking rizatriptan.

If you’re not sure about which over-the-counter medications, prescription drugs, herbal supplements or vitamins are safe to take with rizatriptan, discuss it with your doctor first. 

Alcohol can worsen migraines or cause new headaches. Be mindful of your alcohol consumption when you’re taking rizatriptan.

Lastly, taking rizatriptan more than 10 days a month can result in medication overuse headaches, so avoid taking it too frequently.

Your doctor can help you find another way to prevent or treat your migraines if necessary.

Precautions Before Taking Rizatriptan

Rizatriptan can increase the chances of potentially serious medical problems in people with certain risk factors.

Always tell your doctor about your full medical history, including current health problems and medications, before taking rizatriptan.

Risk factors

In some people, rizatriptan can increase the risk of heart attack and stroke due to the narrowing of blood vessels.

The following risk factors may contribute to serious medical problems when you take rizatriptan:

• History of heart problems 
• History of stroke
• Family history of heart disease
• Age older than 65
• Being overweight 
• Having diabetes
• High blood pressure
• Smoking tobacco 

If any of the above describes you, tell your doctor before taking rizatriptan.

Rizatriptan Alternatives

If rizatriptan doesn’t effectively treat your migraines or you are unable to take it due to underlying risk factors or drug interactions, there are many other treatment options.

You may consider taking an over-the-counter medication alone, such as:

• Ibuprofen (Advil and Motrin)
• Naproxen (Aleve)
• Aspirin 
• Acetaminophen (Tylenol)
• Excedrin, which contains aspirin, acetaminophen, and caffeine

If you are able to take triptans, but rizatriptan alone doesn’t treat your migraine, talk to your doctor about taking rizatriptan with ibuprofen (if you don’t have any contraindications to NSAIDs).

The synergistic effect of the ibuprofen along with rizatriptan can often aid in stopping the migraine headache when rizatriptan alone didn’t help.

Another triptan may also help your migraine.

Other triptans approved by the FDA as acute migraine treatment include:

• Sumatriptan (Imitrex, Imitrex Statdose, Sumavel DosePro, Alsuma, Zembrace SymTouch)
• Eletriptan (Relpax)
• Naratriptan (Amerge)
• Zolmitriptan (Zomig, Zomig ZMT)
• Frovatriptan (Frova)
• Almotriptan (Axert)

Calcitonin gene-related peptide (CGRP) antagonists are a newer drug class used to treat acute migraine. Examples of CGRP antagonists for migraines include: 

• Ubrogepant (Ubrelvy)
• Rimegepant (Nurtect ODT)

If acute medications don’t help, or you get frequent migraines, your doctor may recommend a preventive migraine medication, such as an antidepressant, CGRP monoclonal antibodies, beta blocker, or calcium channel blocker.

When to See a Medical Provider

If you have persistent headaches that don’t respond to rizatriptan or other drugs, talk to your healthcare provider.

A doctor can help you identify a medication that can prevent or treat your migraines.

If you are having new or worsening headaches, get an exam with a doctor to evaluate for underlying causes.

Tell your doctor if you are experiencing unwanted rizatriptan side effects, or if you start taking a new medication that could interact with rizatriptan. 

Call 9-1-1 or visit an emergency department right away if you experience signs of a heart attack, stroke, or serotonin syndrome after taking rizatriptan. 

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