Maxalt (rizatriptan benzoate)
OTHER BRAND NAMES
Acute treatment of migraine with or without aura in adults and in pediatric patients 6-17 yrs of age.
W/ or w/o Aura:
Initial: 5mg or 10mg single dose; separate repeat doses by at least 2 hrs if migraine returns
Max: 30mg/24 hrs
W/ or w/o Aura:
<40kg: 5mg single dose
≥40kg: 10mg single dose
5mg single dose
Max: 5mg/24 hrs
5mg single dose
Max: 3 doses/24 hrs
Start at lower end of dosing range
Do not remove blister from outer pouch until just prior to dosing
Peel open w/ dry hands and place tab on tongue, where it will dissolve and be swallowed w/ saliva
Tab: 5mg, 10mg; Tab, Disintegrating: (MLT) 5mg, 10mg
Ischemic coronary artery disease (CAD) (angina pectoris, history of MI, or documented silent ischemia) or other significant underlying cardiovascular (CV) disease, coronary artery vasospasm (eg, Prinzmetal's angina), history of stroke or transient ischemic attack (TIA), peripheral vascular disease (PVD), ischemic bowel disease, uncontrolled HTN, hemiplegic/basilar migraine. Recent use (within 24 hrs) of another 5-HT1 agonist or ergotamine-containing/ergot-type medication (eg, dihydroergotamine, methysergide). Concurrent use or recent discontinuation (within 2 weeks) of an MAO-A inhibitor.
Use only when diagnosis of migraine has been clearly established. If no response after the 1st migraine attack, reconsider diagnosis before treating subsequent attacks. Not indicated for prevention of migraine attacks. Serious cardiac adverse reactions, including acute MI, reported. May cause coronary artery vasospasm (Prinzmetal's angina). Perform CV evaluation prior to therapy with multiple CV risk factors; consider administering 1st dose in a medically supervised setting and perform ECG immediately following administration in patients with a negative CV evaluation. Consider periodic CV evaluation in intermittent long-term users who have CV risk factors. Life-threatening cardiac rhythm disturbances (eg, ventricular tachycardia/fibrillation leading to death) reported; d/c if these occur. Sensations of tightness, pain, pressure, and heaviness in precordium, throat, neck, and jaw, usually of noncardiac origin, commonly occur after treatment; evaluate if cardiac origin is suspected. Cerebral/subarachnoid hemorrhage and stroke reported; d/c if cerebrovascular event occurs. Evaluate for other potentially serious neurological conditions before treatment. May cause noncoronary vasospastic reactions (eg, peripheral vascular ischemia, GI vascular ischemia, splenic infarction, Raynaud's syndrome); rule out before administering additional doses if experiencing signs/symptoms of noncoronary vasospasms. Transient and permanent blindness and significant partial vision loss reported. Overuse of acute migraine drugs may lead to exacerbation of headache (medication overuse headache); detoxification, including withdrawal of the overused drugs, and treatment of withdrawal symptoms may be necessary. Serotonin syndrome may occur; d/c if serotonin syndrome is suspected. Significant elevation in BP, including hypertensive crisis with acute impairment of organ systems, reported. Caution in elderly. (Tab, Disintegrating) Contains phenylalanine.
Paresthesia, dry mouth, nausea, dizziness, somnolence, asthenia/fatigue, pain/pressure sensation.
See Contraindications. Increased plasma area under the curve with propranolol; adjust dose. Serotonin syndrome reported with SSRIs, SNRIs, and TCAs.
PREGNANCY AND LACTATION
Category C, caution in nursing.
MECHANISM OF ACTION
5-HT1B/1D receptor agonist; binds with high affinity to human cloned 5-HT1B/1D receptors located on intracranial blood vessels and sensory nerves of the trigeminal system.
Absorption: Complete. Absolute bioavailability (45%) (tab); Tmax=1-1.5 hrs (tab), delayed by up to 0.7 hr (tab, disintegrating). Distribution: Vd=140L (male), 110L (female); plasma protein binding (14%). Metabolism: Oxidative deamination by MAO-A; N-monodesmethyl-rizatriptan (active metabolite). Elimination: Urine (82%; 14% unchanged, 51% indole acetic acid metabolite), feces (12%); T1/2=2-3 hrs.
Assess for ischemic CAD or other significant underlying CV disease, history of stroke or TIA, PVD, ischemic bowel disease, uncontrolled HTN, hemiplegic/basilar migraine, neurological conditions, phenylketonuria, drug hypersensitivity, pregnancy/nursing status, and possible drug interactions. Perform CV evaluation with multiple CV risk factors.
Monitor for coronary artery vasospasm, cardiac rhythm disturbances, cerebrovascular event, noncoronary vasospastic reactions, serotonin syndrome, BP elevation, and other adverse reactions. Consider periodic CV evaluation in intermittent long-term users who have CV risk factors.
Inform of possible serious CV side effects, including chest pain, SOB, weakness, and slurring of speech, and to seek medical advice in the presence of such symptoms. Caution about the risk of serotonin syndrome. Advise to notify physician if pregnant, breastfeeding, or planning to breastfeed. Instruct to evaluate their ability to perform complex tasks during migraine attacks and after administration. Inform that overuse (≥10 days/month) may lead to exacerbation of headache; encourage to record headache frequency and drug use. (Tab, Disintegrating) Inform phenylketonuric patients that tab contains phenylalanine.
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