Maxalt (rizatriptan benzoate) is a prescription medication specifically formulated for the acute treatment of migraine with or without aura in adults. It belongs to the class of drugs known as selective serotonin receptor agonists (triptans), which work by narrowing blood vessels around the brain and blocking pain pathways associated with migraine headaches. This targeted action helps to alleviate the debilitating pain, nausea, and sensitivity to light and sound that characterize migraine episodes, allowing for a rapid return to normal function. It is not intended for the prevention of migraines or the treatment of other types of headache, such as cluster headaches.

Features

• Active ingredient: Rizatriptan benzoate
• Available in standard oral tablets and orally disintegrating tablets (Maxalt-MLT)
• Dosage strengths: 5 mg and 10 mg
• Rapid disintegration of the MLT formulation without the need for water
• Designed for portability and discreet use

Benefits

• Provides rapid relief from the intense pain of a migraine attack, often within 2 hours for many patients.
• Effectively reduces or eliminates associated migraine symptoms, including nausea, vomiting, photophobia (sensitivity to light), and phonophobia (sensitivity to sound).
• The orally disintegrating tablet format offers convenience for administration when nausea is present or water is not readily available.
• Helps restore functional ability, allowing for a quicker return to daily activities, work, and social engagements.
• Targeted mechanism of action addresses the complex pathophysiology of a migraine, not just masking the pain.

Common use

Maxalt is indicated for the acute treatment of migraine attacks with or without aura in adults. It is most effective when taken at the very first sign of migraine pain. It is not to be used to prevent migraines or to treat hemiplegic or basilar migraines. Patients should not exceed the maximum dosage in a 24-hour period.

Dosage and direction

The recommended starting dose for most adults is 10 mg. If the migraine returns, a second dose may be taken at least 2 hours after the first dose. The maximum dose in a 24-hour period is 30 mg. For patients on propranolol, the recommended dose is 5 mg, with a maximum of 15 mg in 24 hours. The standard tablet should be taken with water. The orally disintegrating tablet (Maxalt-MLT) should be placed on the tongue, where it will dissolve and be swallowed with saliva; no water is needed. Do not break the blister pack until ready to take the tablet.

Precautions

• Use only after a clear diagnosis of migraine has been established by a healthcare professional.
• Not for use in patients with uncontrolled hypertension, significant heart disease, or a history of stroke or transient ischemic attack (TIA).
• Use with caution in patients with risk factors for heart disease (e.g., hypertension, high cholesterol, diabetes, smoking, obesity, strong family history) unless a cardiovascular evaluation provides satisfactory evidence of heart health.
• May cause dizziness or drowsiness; patients should not drive or operate machinery until they know how Maxalt affects them.
• Serotonin syndrome, a potentially life-threatening condition, is a risk, especially when used concomitantly with other serotonergic drugs (e.g., SSRIs, SNRIs).
• Can cause medication-overuse headaches if used too frequently (e.g., on 10 or more days per month).

Contraindications

• History of ischemic heart disease (e.g., angina pectoris, history of myocardial infarction, silent ischemia)
• Coronary artery vasospasm, including Prinzmetal’s angina
• Uncontrolled hypertension
• History of stroke or transient ischemic attack (TIA)
• Peripheral vascular disease
• Ischemic bowel disease
• Hemiplegic or basilar migraine
• Hypersensitivity to rizatriptan or any component of the formulation
• Concurrent administration or within 2 weeks of discontinuing MAO-A inhibitors
• Concurrent use with other 5-HT1 agonists (e.g., other triptans) or ergotamine-containing medications

Possible side effects

The most common side effects are generally mild and transient. They may include:

• Dizziness
• Drowsiness/somnolence
• Fatigue or tiredness
• Pain or pressure sensation in the chest, neck, throat, or jaw (non-cardiac)
• Nausea
• Dry mouth
• Paresthesia (tingling sensation) Less common but serious side effects require immediate medical attention:
• Symptoms of heart attack (chest pain, jaw or left arm pain, shortness of breath)
• Symptoms of stroke (sudden numbness or weakness, confusion, trouble speaking, vision problems)
• Severe stomach pain or bloody diarrhea (signs of ischemic colitis)
• Significant hypertension
• Symptoms of serotonin syndrome (agitation, hallucinations, fast heartbeat, dizziness, loss of coordination, nausea)

Drug interaction

Maxalt has several important drug interactions:

• Monoamine Oxidase-A Inhibitors (MAOIs): Contraindicated. Risk of increased systemic exposure to rizatriptan and serotonin syndrome.
• Propranolol: Increases the plasma concentration of rizatriptan. A 5 mg dose of Maxalt is recommended for patients taking propranolol.
• Other Serotonergic Drugs: Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) may increase the risk of serotonin syndrome.
• Ergot-Containing Drugs: Contraindicated due to prolonged vasoconstrictive effects (e.g., ergotamine, dihydroergotamine).
• Other 5-HT1 Agonists (Triptans): Contraindicated within 24 hours of each other.

Missed dose

Maxalt is not taken on a scheduled basis. It is taken only at the onset of a migraine attack. Therefore, the concept of a “missed dose” does not apply. Do not take a dose to make up for a migraine you did not treat.

Overdose

Symptoms of overdose may be an exaggeration of the drug’s known effects, including severe dizziness, drowsiness, fainting, bradycardia (slow heart rate), vomiting, and loss of coordination. In cases of suspected overdose, contact a poison control center (1-800-222-1222) or emergency room immediately. Hospitalization and supportive care are the mainstays of treatment, with monitoring of vital signs and ECG.

Storage

Store Maxalt tablets at room temperature between 20°C to 25°C (68°F to 77°F). Excursions are permitted between 15°C and 30°C (59°F and 86°F). Keep the tablets in their original blister pack to protect them from moisture and light. Keep all medications out of the reach of children and pets.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.

Reviews

• “As a long-time migraine sufferer, Maxalt has been a game-changer. The MLT version is a lifesaver when I’m nauseous and can’t keep water down. It starts working within 45 minutes for me, aborting the migraine before it becomes completely debilitating.” – Sarah K., 42
• “My neurologist prescribed Maxalt after other triptans caused too many side effects. The 5mg dose is effective for my moderate migraines with minimal drowsiness. I appreciate having a treatment that allows me to stay productive at work.” – Michael T., 35
• “It doesn’t work for every single one of my migraines, but when it does, the relief is profound. The chest tightness side effect was unsettling at first, but my doctor assured me it was non-cardiac. The benefits far outweigh this temporary discomfort.” – Jennifer L., 50
• “The cost can be prohibitive without insurance, but the efficacy is undeniable. For my severe migraines with aura, taking a 10mg tablet at the first sign of visual disturbances often stops the attack in its tracks.” – David R., 29