Rizatriptan

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Jan 23, 2024

Warnings

Rizatriptan (Maxalt) Risks, Warnings, and Complications

Rizatriptan can cause serious adverse effects and health problems in some people. Talk to your doctor or pharmacist about other options for acute treatment of migraine if you are at increased risk of complications from rizatriptan use.

SERIOUS CARDIOVASCULAR EVENTS: Rizatriptan is not safe for people with ischemic or vasospastic coronary artery disease. There are rare reports of an acute myocardial infarction (heart attack) within hours of taking this medicine. Rizatriptan can also cause angina (chest pain) in people with no history of coronary artery disease. A small number of people have developed life-threatening cardiac arrhythmias, such as ventricular fibrillation and ventricular tachycardia, within hours of taking Maxalt (rizatriptan).
Do not take rizatriptan if you have significant underlying cardiovascular disease. If you have a high risk of coronary artery disease (for example, diabetes, hypertension, smoking, or a family history of coronary artery disease), your doctor will probably send you for a cardiovascular evaluation before starting rizatriptan. If you receive clearance, they will give you the initial dose of rizatriptan in a medically supervised setting.
CHEST, THROAT, NECK, AND JAW PAIN, TIGHTNESS, PRESSURE OR HEAVINESS: Rizatriptan can cause pain, pressure, tightness, or heaviness in the jaw, neck, throat, or chest. These symptoms are usually temporary and go away on their own. However, they can also be signs of a heart attack. If you have persistent or worsening jaw, neck, or chest pain or tightness, get emergency medical help.
CEREBROVASCULAR EVENTS: There are reports of life-threatening and fatal cerebrovascular events such as stroke and brain hemorrhage after taking Maxalt (rizatriptan). It is possible that the stroke or brain hemorrhage was already occurring, and these individuals took rizatriptan, wrongly believing that their symptoms were from a migraine headache. Notably, people with migraine headaches are at an increased risk of cerebrovascular events like stroke and brain hemorrhage.
Your healthcare provider will not prescribe rizatriptan if you have a history of stroke or transient ischemic attack. Tell your doctor immediately or seek emergency medical attention if you develop signs of stroke (numbness or weakness in a limb, vision changes, sudden severe headache).
VASOSPASM REACTIONS: Rizatriptan works by narrowing blood vessels in the brain. This medicine can also cause vasospasm reactions in the limbs (peripheral vascular ischemia), gastrointestinal tract, and eyes. There are reports of temporary and permanent vision loss after taking rizatriptan. However, because visual changes can occur in migraine attacks, a direct causal relationship between visual disorders and rizatriptan has not been established. Tell your doctor without delay if you develop eye pain or vision changes like blurred vision.
MEDICATION OVERUSE HEADACHE: Taking Maxalt (rizatriptan) or other headache medications more than 10 days a month can trigger headache pain and result in rebound headaches or medication overuse headaches. Tell your healthcare provider if you need to take rizatriptan more than 4 times a month, if it makes your headaches worse, or if you have more frequent headaches. Detoxification may be necessary by discontinuation of the medicine for some time.
SEROTONIN SYNDROME: Rizatriptan can cause a life-threatening condition called serotonin syndrome. Risk factors include taking other serotonergic medications, such as a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI), which are commonly prescribed antidepressants. This can lead to dangerously high levels of serotonin in the body. Get emergency medical help if you develop serotonin syndrome symptoms such as sudden confusion, hallucinations, agitation, mental status changes, nausea, vomiting, diarrhea, or muscle tightness.
HYPERTENSION: Rarely, Maxalt (rizatriptan) can lead to a significant increase in blood pressure, including a hypertensive crisis, even in people with no history of high blood pressure. This medication is not safe for people with uncontrolled high blood pressure. Even in healthy individuals with normal blood pressure, it can lead to a slight increase in blood pressure readings.

Precautions Before Starting Rizatriptan (Maxalt)

Do not use rizatriptan to treat occasional or mild headache pain that is not migraine. Make sure you have received a diagnosis of migraine before starting treatment with rizatriptan. Your doctor will evaluate your headache symptoms and ensure they are not some other type of headache, such as hemiplegic or basilar migraine, common tension headache, or cluster headache.

Tell your doctor if you are allergic to rizatriptan, any of the active or inactive ingredients in rizatriptan formulations, any other triptans, or any other medications. Your pharmacy can give you a list of ingredients.

If you have phenylketonuria (PKU), don’t take the orally disintegrating tablets of rizatriptan (Maxalt MLT) because they contain aspartame, which can form into phenylalanine in the body.

Give your doctor and pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, vitamins, supplements, and herbal products. This can help avoid possible drug interactions.

Give your doctor a complete medical history. Rizatriptan may not be safe for people with certain medical conditions such as heart disease, heart attack, angina (chest pain), arrhythmias (irregular heartbeats), stroke, transient ischemic attack, or mini-stroke, circulation problems, peripheral vascular disease, blood clots in the legs, varicose veins, Raynaud's disease, and ischemic bowel disease (decreased blood flow to the intestines). Also, tell your doctor if you are overweight, postmenopausal, or have high blood pressure, high cholesterol, diabetes, liver or kidney disease, or a family history of heart disease or stroke.

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding. If you are sexually active, discuss appropriate birth control with your provider before starting rizatriptan.

Precautions During Use of Rizatriptan (Maxalt)

Keep all your medical appointments while on rizatriptan. Your doctor may adjust your dose and will monitor you for side effects and medication overuse headaches.

Rizatriptan can cause drowsiness and dizziness. Do not drive or do anything that requires your full concentration until you know how this medicine affects you.

Tell your doctor if you become pregnant while on rizatriptan.

Rizatriptan (Maxalt) Drug Interactions

Certain other drugs can affect how rizatriptan works. Possible interactions between rizatriptan and other medicines can increase the risk of severe adverse effects. Your doctor may adjust the dose of your medicines, switch you over to another migraine headache medicine, or monitor you carefully for side effects if there are known interactions between rizatriptan and your other medications.

Do not take rizatriptan if you have taken any of these medications within the last 24 hours:

Other migraine headache medicines (triptans or selective serotonin receptor agonists) such as eletriptan (Relpax), sumatriptan (Imitrex, in Treximet), almotriptan (Axert), naratriptan (Amerge), or zolmitriptan (Zomig)
Ergot-type medications such as cabergoline, bromocriptine (Parlodel), dihydroergotamine (Migranal, D.H.E. 45), ergonovine (Ergotrate), ergoloid mesylates (Hydergine), ergotamine (Cafergot, Ergomar), methysergide (Sansert), methylergonovine (Methergine), and pergolide (Permax)

Do not take rizatriptan if you have taken monoamine oxidase inhibitors such as phenelzine (Nardil), isocarboxazid (Marplan), or tranylcypromine (Parnate) in the past 2 weeks.

The following medications can also have drug interactions with rizatriptan:

Acetaminophen (Tylenol)
Aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Aleve)
Tricyclic antidepressants such as amitriptyline (Elavil), nortriptyline (Aventyl, Pamelor), clomipramine (Anafranil), imipramine (Tofranil), amoxapine (Asendin), doxepin (Adapin, Sinequan), desipramine (Norpramin), protriptyline (Vivactil), and trimipramine (Surmontil)
Selective serotonin reuptake inhibitors such as sertraline (Zoloft), fluoxetine (Prozac, Sarafem, in Symbyax), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), and fluvoxamine
Selective serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta), venlafaxine (Effexor), desvenlafaxine (Pristiq), and sibutramine (Meridia)
Beta-blockers such as propranolol (Inderal)

The above list does not describe all the adverse reactions that can occur if you take rizatriptan with certain other drugs. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, OTC medications, dietary supplements, and herbal remedies. Also, tell your doctor or pharmacist if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

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