Maxalt (rizatriptan benzoate) is a prescription medication specifically formulated for the acute treatment of migraine attacks 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. This targeted action helps to alleviate the debilitating pain, nausea, and sensitivity to light and sound associated with migraines, 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 at the onset of migraine symptoms

Benefits

• Provides significant relief from migraine headache pain within 2 hours for a majority of users.
• Effectively reduces or eliminates associated migraine symptoms, including nausea, photophobia, and phonophobia.
• The fast-dissolving MLT formulation offers convenience and ease of administration, even when feeling nauseated.
• Helps restore normal function, allowing for a quicker return to daily activities and work.
• Offers a proven, targeted therapeutic option for those who do not respond adequately to simple analgesics.

Common use

Maxalt is indicated for the acute treatment of migraine attacks. It is most effective when taken at the very first sign of migraine pain. It is not to be used to treat a common tension headache or for prophylactic (preventative) migraine therapy. Patients should not exceed the maximum recommended dosage in a 24-hour period.

Dosage and direction

The recommended dose is either 5 mg or 10 mg. The 10 mg dose may provide a greater effect, but some patients may have a better overall response to the 5 mg dose, especially if they experience side effects. A second dose may be taken if the headache returns, but no sooner than 2 hours after the first dose. The maximum dose in a 24-hour period is 30 mg. For patients taking propranolol, the recommended initial dose is 5 mg, with a maximum of 15 mg in 24 hours. Tablets should be taken with liquid. Orally disintegrating tablets (MLT) should be placed on the tongue, where they will dissolve and be swallowed with saliva; no liquid is needed.

Precautions

• Use only after a clear diagnosis of migraine has been established.
• Not recommended for use in patients with risk factors for heart disease (e.g., hypertension, high cholesterol, smoking, obesity, diabetes, strong family history) unless a cardiovascular evaluation provides satisfactory evidence that the patient is free of underlying cardiovascular disease.
• Should not be used in patients with hemiplegic or basilar migraine.
• Use with caution in patients with hepatic impairment; a maximum dose of 5 mg is recommended for these patients.
• May cause drowsiness or dizziness; patients should assess their individual response before operating machinery or driving.

Contraindications

• History of ischemic heart disease (e.g., angina pectoris, history of myocardial infarction, documented silent ischemia).
• History of coronary artery vasospasm, including Prinzmetal’s variant angina.
• Uncontrolled hypertension.
• History of stroke or transient ischemic attack (TIA).
• Peripheral vascular disease.
• Ischemic bowel disease.
• 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 or ergot-type medications (e.g., dihydroergotamine, methysergide).
• Concurrent administration or within 2 weeks of discontinuation of MAO-A inhibitors.

Possible side effects

The most common side effects are generally mild to moderate and transient.

• Dizziness
• Drowsiness (somnolence)
• Fatigue or tiredness
• Pain or pressure sensation in the chest, neck, throat, or jaw (not necessarily related to cardiac issues, but any such sensations must be reported to a physician immediately)
• Nausea
• Dry mouth
• Paresthesia (tingling sensation)

Serious but rare side effects include: coronary artery vasospasm, transient myocardial ischemia, myocardial infarction, ventricular tachycardia, ventricular fibrillation, stroke, GI ischemic events, and serotonin syndrome.

Drug interaction

Significant and potentially dangerous interactions exist. Inform your doctor of all medications you are taking.

• MAO-A Inhibitors: Contraindicated. Can drastically increase rizatriptan plasma levels.
• Propranolol: Increases the plasma concentration of rizatriptan. Dose adjustment of Maxalt is required.
• Other Triptans and Ergot Derivatives: Contraindicated due to additive vasoconstrictive effects.
• SSRIs/SNRIs (e.g., fluoxetine, sertraline, venlafaxine): Concomitant use may increase the risk of serotonin syndrome, a potentially life-threatening condition.
• Other 5-HT1 receptor agonists.

Missed dose

Maxalt is not taken on a scheduled basis; it is used only to treat an acute 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 include severe dizziness, drowsiness, fainting, slow heart rate, vomiting, and loss of coordination. In cases of massive overdose, hypertension, more serious cardiovascular events, or seizures are possible. There is no specific antidote. Treatment consists of supportive measures, including continuous ECG monitoring for at least 20 hours and management of symptoms. The patient’s stomach may be emptied by gastric lavage, and activated charcoal may be administered.

Storage

Store 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 or bottle to protect from light and moisture. 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 too nauseous to swallow a pill. Relief usually starts within 45 minutes for me.” – Sarah K., 42
• “I’ve tried several triptans, and Maxalt 10mg works the fastest and most consistently for my severe migraines. It allows me to abort an attack and get back to my workday.” – Mark T., 38
• “Effective, but I did experience some tightness in my chest and jaw with the 10mg dose. My doctor switched me to 5mg, which works almost as well without that side effect.” – Jennifer L., 51
• “It doesn’t work for every single one of my migraines, but it succeeds about 80% of the time. That’s a significant improvement in my quality of life.” – David R., 29