Rizatriptan (Maxalt®) Indications / Dosage
Rizatriptan (Maxalt®) Indications / Dosage
For the treatment of acute migraine attacks with or without aura:
NOTE: Rizatriptan is NOT approved for prophylactic migraine therapy or for the treatment of hemiplegic or basilar migraines or cluster headaches.
- for treatment of migraine using rizatriptan as a single agent:
Oral dosage:
Adults: 5 - 10 mg PO as a single dose at migraine onset. May repeat every 2 hours with no more than 30 mg in any 24-hour period. There is evidence that the 10 mg dose may be more efficacious than the 5 mg dose; therefore, the appropriate dose should be based on an individual basis with consideration of the potential for side effects. Rizatriptan is NOT approved for prophylactic migraine therapy or for the treatment of hemiplegic or basilar migraines or cluster headaches.
Elderly: See adult dosage; data are limited. Not recommended in those > 71 years due to lack of data.
Adolescents and children >= 6 years † : Results from a double-blind, placebo-controlled, crossover trial showed rizatriptan was effective for the treatment of migraine attacks in pediatric patients 6 - 17 years of age. Children with a body weight of 20 - 39 kg received a dose of 5 mg and children with a body weight of >= 40 kg received a dose of 10 mg. Three migraine attacks were studied with 2 attacks treated with rizatriptan and 1 attack with placebo in a blinded, random assignment. The primary endpoint was a reduction in severity of headache pain by at least 2 grades on the five-face pain intensity scale (5 = severe, 4 - 3 = moderate, 2 = mild, 1 = no pain) at 2 hours. Only migraines classified as >= 3 on the pain scale were treated with the study drug regimen. Of the 96 patients who completed the study, rizatriptan 5 mg and 10 mg were significantly more effective than placebo, with the primary endpoint attained in 74% and 73% of patients following the first and second rizatriptan treatment phases versus 36% during the placebo phase. Overall, side efffects were minimal (see Adverse Reactions).
Children < 6 years: Safe and effective use has not been established.
- for treatment of migraine in patients who are receiving concomitant therapy with propranolol:
Oral dosage:
Adults: 5 mg PO at migraine onset. May repeat every 2 hours with no more than 15 mg PO in any 24-hour period.
Elderly: See adult dosage; data are limited. Not recommended in those > 71 years due to lack of data.
Adolescents and children: Safety and efficacy have not been established.
Maximum Dosage Limits:
- Adults: 30 mg/day PO per 24 hour period. If also receiving propranolol, do not exceed 15 mg/day PO. The safety of treating > 4 headaches in a 30-day period is not established.
- Elderly <= 71 years: 30 mg/day PO per 24 hour period. If also receiving propranolol, do not exceed 15 mg/day PO. The safety of treating > 4 headaches in a 30-day period is not established.
- Elderly > 71 years: Not recommended.
- Adolescents: Single doses of 5 mg for adolescents weighing 20 - 30 kg and 10 mg for adolescents weighing >= 40 kg have been used.
- Children >= 6 years: Single doses of 5 mg for children weighing 20 - 30 kg and 10 mg for children weighing >= 40 kg have been used.
- Children < 6 years: Safe and effective use has not been established.
Patients with hepatic impairment:
Use rizatriptan cautiously in patients with moderate to severe hepatic dysfunction due to increased plasma concentrations of at least 30%.
Patients with renal impairment:
CrCl >= 10 ml/min: no dosage adjustment needed.
CrCl < 10 ml/min: use rizatriptan with caution in dialysis patients as decreased clearance results in increased AUC.
Intermittent hemodialysis:
See dosage for patients with renal impairment. It is not known whether hemodialysis (or peritoneal dialysis) removes rizatriptan from plasma.
[ Last revised: 9/21/2006 4:54:00 PM ]
References
. Ahonen K, Hamalainen ML, Eerola M, et al. A randomized trial of rizatriptan in migraine attacks in children. Neurology 2006;67:1 - 6.
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