Maxalt (rizatriptan benzoate) is a prescription medication specifically formulated for the acute treatment of migraine headaches 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 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 Formulations: Oral tablets (standard and orally disintegrating tablets - ODT) and orally disintegrating wafers
• Standard Tablet Strengths: 5 mg and 10 mg
• Orally Disintegrating Tablet (Maxalt-MLT) Strengths: 5 mg and 10 mg
• Rapid Disintegration: ODT formulation dissolves on the tongue without the need for water
• Rapid Absorption: Designed for quick systemic absorption to address migraine symptoms promptly

Benefits

• Provides rapid relief from the intense, throbbing pain characteristic of migraine headaches.
• Effectively reduces associated migraine symptoms, including nausea, vomiting, photophobia (sensitivity to light), and phonophobia (sensitivity to sound).
• The orally disintegrating tablet (ODT) formulation offers a convenient, discreet dosing option, ideal for situations where water is not readily available or swallowing is difficult due to nausea.
• Helps restore functional capacity, allowing for a quicker return to daily activities, work, and social engagements.
• Targeted mechanism of action works on the specific pathophysiology of a migraine attack, unlike general pain relievers.

Common use

Maxalt is indicated for the acute treatment of migraine attacks 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 take Maxalt for a headache that is different from their usual migraine. Its use should be limited to treating an active migraine attack and should not exceed the maximum dosage in a 24-hour period.

Dosage and direction

The recommended initial dose for most adults is 5 mg or 10 mg. If the headache returns, a second dose may be taken after at least 2 hours, not to exceed a total of 30 mg in any 24-hour period.

• Standard Tablets: Should be swallowed whole with water.
• Orally Disintegrating Tablets (ODT): The blister pack should be peeled open with dry hands. The tablet must be placed on the tongue immediately, where it will dissolve rapidly and be swallowed with saliva. No liquid is needed. Dosage adjustment is necessary for patients on propranolol; the recommended dose is 5 mg, with a maximum of 15 mg in 24 hours. The safety of treating more than four headaches in a 30-day period has not been established.

Precautions

• Maxalt should only be used where a clear diagnosis of migraine has been established.
• Use with caution in patients with risk factors for coronary artery disease (e.g., hypertension, high cholesterol, obesity, diabetes, strong family history, or postmenopausal women) unless a cardiovascular evaluation provides satisfactory evidence that the patient is free of underlying cardiovascular disease.
• Not recommended for use in patients with significant hepatic impairment.
• May cause drowsiness or dizziness. Patients should be advised to evaluate their ability to perform complex tasks, such as operating machinery or driving, after taking Maxalt.
• Serotonin syndrome, a potentially life-threatening condition, is a risk, particularly with concomitant use of other serotonergic drugs.

Contraindications

• History of ischemic heart disease (e.g., angina pectoris, history of myocardial infarction, or documented silent ischemia)
• Coronary artery vasospasm, including Prinzmetal’s angina
• Uncontrolled or severe 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 administration of other 5-HT1 agonists (other triptans) or ergotamine-containing medications

Possible side effect

Like all medications, Maxalt can cause side effects, although not everybody gets them. Common side effects are usually mild to moderate and transient.

• Very Common (≥1/10): Dizziness, somnolence (sleepiness), fatigue/asthenia (tiredness)
• Common (≥1/100 to <1/10): Pain/pressure sensation in chest, neck, throat, or jaw; nausea; dry mouth; vomiting; palpitations; tachycardia (increased heart rate); diaphoresis (sweating)
• Uncommon (≥1/1,000 to <1/100): Syncope (fainting), hypotension (low blood pressure), bradycardia (slow heart rate), Raynaud’s phenomenon, urticaria (hives), pruritus (itching)
• Rare but serious side effects requiring immediate medical attention include symptoms of heart problems (chest pain, shortness of breath, irregular heartbeat), signs of a stroke (sudden numbness/weakness, confusion, trouble speaking), severe abdominal pain, bloody diarrhea, and symptoms of serotonin syndrome (agitation, hallucinations, fever, fast heart rate, muscle stiffness, loss of coordination, nausea/vomiting/diarrhea).

Drug interaction

Maxalt has several important drug interactions that must be considered to avoid serious adverse events.

• Monoamine Oxidase-A Inhibitors (MAO-A Inhibitors): Contraindicated. Concurrent use can drastically decrease the clearance of rizatriptan, leading to a significantly increased risk of side effects.
• Propranolol: Concurrent use increases the plasma concentration of rizatriptan. The Maxalt dose must be reduced to 5 mg, with a maximum of 15 mg in 24 hours.
• Other 5-HT1 Agonists (Triptans) and Ergot Derivatives: Contraindicated. Concomitant use may prolong vasospastic reactions and is not recommended within 24 hours of each other.
• Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Concomitant use may potentially lead to serotonin syndrome (weakness, hyperreflexia, incoordination).
• Other Serotonergic Drugs: Use with caution with other drugs that increase serotonin levels.

Missed dose

Maxalt is not taken on a scheduled basis; it is taken only to treat an acute migraine attack as needed. Therefore, the concept of a “missed dose” does not apply. Do not take a dose to make up for a migraine attack you did not treat. Simply take it at the onset of your next migraine attack, following the prescribed dosage instructions.

Overdose

In cases of overdose, supportive measures should be instituted. The patient should be monitored for cardiovascular effects, and ECG monitoring is recommended. The elimination of rizatriptan may be prolonged by propranolol. There is no specific antidote for rizatriptan overdose. The maximum single dose administered in clinical trials was 40 mg, which was tolerated by healthy volunteers. Reported symptoms of overdose could include dizziness, drowsiness, fainting, tachycardia, bradycardia, hypotension, vomiting, and loss of coordination.

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).
• Standard Tablets: Keep in the original blister pack until time of use. Protect from light and moisture.
• Orally Disintegrating Tablets (ODT): Keep the blister pack in the outer carton to protect from light and moisture. Handle the blister with dry hands when opening. Do not push the tablet through the foil blister.
• 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. The information provided may not cover all possible uses, directions, precautions, drug interactions, or adverse effects.

Reviews

• “As a long-time migraine sufferer, Maxalt has been a game-changer. The ODT version is a lifesaver when I’m nauseous and can’t keep water down. It starts working within 30 minutes for me, allowing me to get back to my workday.” - Sarah K., 42
• “I’ve tried other triptans, but Maxalt provides the most consistent and rapid relief for my severe migraines. The chest tightness is a noticeable side effect for me, but the trade-off for pain relief is worth it. My neurologist and I have decided the benefits outweigh this side effect in my case.” - Michael T., 51
• “Effective but use sparingly. It works incredibly well to abort my migraines, but I have to be very careful about the maximum monthly usage to avoid medication-overuse headaches. It’s a powerful tool in my arsenal, but not one to be used lightly.” - Jennifer L., 38
• “The 10mg tablet works reliably for my wife’s classic migraines with aura. We appreciate having a treatment that can stop an attack in its tracks and prevent her from being bedridden for a full day.” - David R. (caregiver)