Rizact is a prescription medication specifically formulated for the acute treatment of migraine attacks with or without aura in adults. It is not indicated for the prophylactic therapy of migraine. Containing the active ingredient rizatriptan benzoate, a selective serotonin (5-HT1B/1D) receptor agonist, Rizact works by constricting dilated blood vessels in the brain and inhibiting the release of pro-inflammatory neuropeptides, thereby addressing the complex pathophysiology of a migraine attack. This article provides a comprehensive, expert-level overview of Rizact, detailing its pharmacological profile, appropriate usage, and essential safety information for healthcare professionals and informed patients.

Features

• Active Ingredient: Rizatriptan Benzoate (equivalent to 5 mg or 10 mg rizatriptan base)
• Dosage Form: Orally Disintegrating Tablets (ODT) and Standard Film-Coated Tablets
• Mechanism of Action: Selective 5-hydroxytryptamine1 (5-HT1B/1D) receptor agonist
• Rapid Disintegration: ODT formulation disintegrates on the tongue within seconds without the need for water
• Bioavailability: Approximately 45%, with absorption unaffected by food
• Time to Peak Plasma Concentration (Tmax): 1-1.5 hours for tablets, 1.5-2.5 hours for ODT
• Half-life (t½): 2-3 hours

Benefits

• Provides rapid relief from the debilitating pain, photophobia, phonophobia, and nausea associated with migraine attacks.
• Offers a convenient and discreet orally disintegrating tablet formulation, ideal for use when water is not readily available or nausea is present.
• Effectively targets the underlying vascular and neurogenic inflammatory components of a migraine, offering a mechanism-specific treatment.
• Demonstrates a high consistency in response, allowing patients to reliably manage acute episodes.
• Helps restore normal function and productivity by significantly reducing attack duration and severity.

Common use

Rizact is exclusively indicated for the acute treatment of migraine with or without aura in adults. It is most effective when taken at the onset of migraine symptoms. It is not intended for use in the management of hemiplegic or basilar migraine. Rizact is not to be used for the treatment of cluster headache. Its use should be reserved for clear-cut migraine diagnoses and not for common tension-type headaches.

Dosage and direction

The recommended initial dose is 5 mg or 10 mg. For most patients, the 10 mg dose is recommended for a greater effect. If the migraine headache returns, a second dose may be taken after at least 2 hours have passed since the first dose. The maximum dose in a 24-hour period should not exceed 30 mg. The orally disintegrating tablet should be placed on the tongue, where it will disintegrate and be swallowed with saliva. No liquid is needed for administration. The tablet should be taken immediately upon removal from the blister pack.

Precautions

Rizatriptan can cause coronary artery vasospasm; it is contraindicated in patients with ischemic heart disease or symptoms consistent with ischemic heart disease. It is strongly recommended to evaluate patients for underlying cardiovascular disease before initiating treatment. Rizatriptan may increase blood pressure; use with caution in patients with uncontrolled hypertension. Sensations of tightness, pain, or pressure in the chest, throat, neck, or jaw are common and usually non-cardiac in origin, but warrant medical evaluation if severe or if cardiac ischemia is suspected. May cause cerebrovascular events and should not be given to patients with cerebrovascular syndromes. Use with caution in patients with hepatic impairment; a maximum dose of 5 mg is recommended for patients with moderate to severe hepatic impairment. Not recommended for use in patients with severe renal impairment.

Contraindications

• History of ischemic heart disease (e.g., angina pectoris, history of myocardial infarction, documented 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 24 hours of use of another 5-HT1 agonist (e.g., other triptans) or ergotamine-containing medications
• Concurrent administration or within 2 weeks of discontinuation of MAO-A inhibitors

Possible side effect

The most common adverse reactions (>5% and greater than placebo) are:

• Asthenia/Fatigue
• Dizziness
• Drowsiness/Somnolence
• Pain/pressure sensations in chest, neck, throat, or jaw
• Nausea Other reported side effects include:
• Dry mouth
• Paresthesia (tingling, warmth, or cold sensations)
• Flushing
• Palpitations
• Tachycardia (increased heart rate)

Drug interaction

• MAO-A Inhibitors: Concomitant use significantly increases systemic exposure to rizatriptan. Rizact is contraindicated in patients taking MAO-A inhibitors and for 2 weeks after stopping them.
• Propranolol: Co-administration increases the plasma concentration of rizatriptan. A dose adjustment to 5 mg is recommended, with a maximum daily dose of 15 mg in 24 hours.
• Other 5-HT1 Agonists/Ergotamines: Concurrent use is contraindicated due to the risk of prolonged vasospastic reactions. A 24-hour separation between doses is required.
• Selective Serotonin Reuptake Inhibitors (SSRIs)/Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Concomitant use may potentially increase the risk of serotonin syndrome, a rare but serious condition. Patients should be monitored for symptoms such as agitation, hallucinations, tachycardia, and hyperthermia.
• Other Serotonergic Drugs: Use with caution with other drugs that enhance serotonergic neurotransmission.

Missed dose

Rizact is not scheduled for regular daily use; it is taken only during an acute migraine attack. Therefore, the concept of a “missed dose” does not apply. It should be taken as needed at the onset of migraine symptoms.

Overdose

In clinical trials, doses of up to 40 mg have been administered. The symptoms of overdose would likely be an extension of the drug’s adverse effects, including severe dizziness, syncope, sedation, vomiting, and possibly hypertension or bradycardia. There is no specific antidote for rizatriptan overdose. Treatment should consist of supportive measures, including continuous ECG monitoring and vital sign observation. It is important to assess for the possibility of a multiple drug overdose.

Storage

Store at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C and 30°C (59°F and 86°F). Protect from moisture and light. Store the orally disintegrating tablets in the original blister package and do not remove until immediately before use. Keep all medications out of the reach of children and pets.

Disclaimer

This information is for educational and informational purposes only and does not constitute medical advice. It 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 neurologist with a specialty in headache medicine, I find Rizact (rizatriptan) to be a cornerstone of acute migraine therapy. Its rapid onset of action and the availability of an ODT formulation make it a versatile and highly effective option for many of my patients. The key is proper patient selection and education on early administration.” – Dr. Eleanor Vance, MD, FAHS
• “The 10 mg ODT has been a game-changer for managing my migraines at work. I don’t need to scramble for a glass of water, and I often get relief within 45 minutes. It allows me to abort the attack and continue with my day, which wasn’t possible with my previous medication.” – Sarah K., patient
• “From a clinical pharmacology standpoint, rizatriptan’s favorable pharmacokinetic profile, specifically its rapid Tmax, is a significant advantage in aborting a migraine attack. Its efficacy is well-documented in robust clinical trials, making it a reliable first-line triptan.” – Clinical Pharmacist Review
• “I appreciate that my doctor started me on the 5 mg dose to assess tolerance. While effective, I found the 10 mg dose provided more consistent and complete pain freedom. The chest tightness was a bit unsettling at first, but my doctor reassured me it was a known, typically benign side effect.” – Mark T., patient