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About rizatriptan

Dr Fox supplies generic rizatriptan 10mg tablets and 10mg dissolve-in-the mouth orodispersible tablets. Original branded versions are also available (Maxalt & Maxalt Melts) at higher cost.

How does rizatriptan work?

Rizatriptan is one of the triptan types of medications. Migraine is linked to temporary swelling of blood vessels inside the head. Triptans work by shrinking the blood vessels back to normal so reducing headache and other migraine symptoms.

Buying rizatriptan online

Always consult your regular doctor to confirm the diagnosis before obtaining supplies of migraine treatment online. Consult your doctor if your symptoms are changing or you experience any new medical conditions or side effects.

Who can take rizatriptan?

Rizatriptan should only be used to treat migraine headaches. It should not be taken for other sorts of headaches. Migraine headaches are typically throbbing and severe, and are associated with nausea, vomiting, and aversion to strong light (photophobia). They tend to be on one side of the head only, but not always. A migraine sometimes begins with an aura (symptoms such as flashing lights or other visual or sensory disturbance) later followed by the headache phase. They usually last a few hours and then go away, with no symptoms between attacks. See NHS migraine page for further details.

Who should not use rizatriptan?

Discuss your treatment with your regular doctor and don't use rizatriptan without approval if any of the following apply:

• Serious liver or kidney disease.
• Over 65 years old.
• If you are a heavy smoker, a man over 40, or a woman past the menopause, you may be at extra risk of developing heart disease and may need extra checks from your doctor before taking rizatriptan.
• Headache is associated with dizziness, loss of coordination, or weakness of an arm or leg.
• Have had a heart attack, stroke, or mini-strokes (TIAs) in the past.
• Problems with poor circulation (peripheral vascular disease).
• Angina (heart pain on exertion).
• Irregular heart rhythm or ECG changes (e.g. bundle branch block).
• Uncontrolled high blood pressure.
• History of fits or seizures.

Do not take rizatriptan if you have a known allergy to other triptans.

Taking rizatriptan with other medicines

Dr Fox checks for interacting medication in the online consultation for migraine treatment.

Other migraine treatments

Rizatriptan is one of the group of medicines called triptans, and it should not be taken at the same time as other triptans used to treat migraine (including naratriptan, sumatriptan, and zolmitriptan).

Other migraine treatments may also interact. These include older treatments like ergotamine and dihydroergotamine. In general leave at least 24 hours between taking these medications and rizatriptan.

Triptans have been used in clinical trials at the same time as Vydura (rimegepant - used as a preventative medication), with no issues reported.

Propranolol (for heart disease, raised blood pressure, anxiety, migraine prevention) may increase the dose of rizatriptan absorbed. Discuss with your GP who may recommend using a lower dose of rizatriptan.

Comparing different triptans

Antidepressant medicines

Rizatriptan should not be taken within 2 weeks of MAOIs (monoamine oxidase inhibitors) antidepressants and can interact with other antidepressants in particular SSRIs and SNRIs and herbal remedies containing St John's Wort. If you are taking any medication for depression/low mood consult your GP about whether you can use rizatriptan.

Other medicines

For further details see the 'other medicines' section of the manufacturers' patient information leaflets, or discuss with your GP or pharmacist.

Can rizatriptan be taken in pregnancy and whilst breastfeeding?

It is not known if rizatriptan is harmful to an unborn baby if taken during pregnancy. Do not take when pregnant or trying to get pregnant, without first discussing with your GP or obstetrician.

You should not breastfeed and expressed breast milk should not be used within 24 hours of taking rizatriptan.

Possible side effects of rizatriptan

Allergy

Do not take rizatriptan if you have a known allergy to other triptans.

Very rarely, serious allergic reactions occur (rash, hives, wheezing, swollen eyelids and face, and collapse). This would require immediate medical attention - telephone 999 in the UK.

Other side effects

Not all people experience side effects, and sometimes the migraine itself can cause similar symptoms.

The most common side effects of rizatriptan (may affect up to 1 in 10 people) include:

• Headache.
• Dizziness, sleepiness, and tiredness.
• Aching, stiffness or weak muscles, heavy feelings.
• Abnormal sensations such as tingling, numbness, hot or cold flushes, over sensitive/less sensitive skin - these can be intense but generally pass quickly.
• Feeling sick (nausea), dry mouth, throat discomfort, vomiting, diarrhoea, indigestion.
• Palpitation.

More serious rare side effects can include:

• Heavy, pressure, tight feelings or pain/discomfort in the throat, neck, arms and chest. If these occur, stop using the medication. If they don't settle within 15-20 minutes or become very severe, get emergency medical help - telephone 999 in the UK. In a very small number of susceptible people triptans can trigger angina or a heart attack.

A full list of side effects can be found in the manufacturers' patient information leaflets.

How to use rizatriptan

Rizatriptan is not a preventative treatment and should only be used for actual migraine headaches.

Treatment works best if taken at the start of a migraine headache (after any aura), but it will also work if taken later in the attack.

How to take rizatriptan and Maxalt tablets

Dr Fox supplies Maxalt and rizatriptan 10mg tablets only. One tablet should be taken as soon as possible after the start of the headache phase of a migraine. The usual dose is 10mg, but in some instances your GP may suggest that a lower 5mg tablet should be used.

The tablet should be swallowed whole with liquid. It works more quickly if taken on an empty stomach, but can still be taken after food. The headache should begin to improve after 30 minutes.

If the headache has not resolved completely by 2 hours, do not take another dose. However if the migraine recurs more than 2 hours after the initial dose, then another 10mg tablet can be taken. The maximum in 24 hours is two doses (20mg) at least 2 hours apart.

Maxalt Melt and rizatriptan orodispersible tablets

These peppermint flavoured tablets dissolve on the tongue and so can be useful if there is marked nausea and vomiting with a migraine attack.

Use one 10mg Maxalt Melt or 10mg rizatriptan orodispersible tablet as soon as the headache phase of the migraine begins.

Carefully remove the tablet from its blister pack with clean, dry hands and place it on your tongue. Leave it to dissolve in the saliva and swallow. There is no need to take a drink with it. If you have a very dry mouth then taking a drink of water before the tablet may help it to dissolve more easily. The tablets are absorbed more quickly if taken on an empty stomach but can still be taken after food.

The headache should improve within 30 minutes. If it hasn't resolved after 2 hours, do not take another tablet. However if it comes back, then you can take another Maxalt Melt or orodispersible tablet within 24 hours. The maximum in 24 hours is two doses (2 x 10mg) at least two hours apart.

Alternative treatments

Migraines will often improve after a few hours lying down in a darkened room.

Simple painkillers, such as ibuprofen and aspirin, may be effective.

Other triptans can be used to treat migraine including naratriptan, sumatriptan, zolmitriptan. It may be worth trying different triptans to find the one which suits you best. If you have tried two different triptans unsuccessfully, then you can try Vydura (rimegepant). It can also be used in many cases where there are medical contraindications to using triptans.

If vomiting is marked, an anti-sickness tablet may also be prescribed - discuss with your regular GP, not prescribed by Dr Fox. Some migraine tablets contain combinations of painkillers and antiemetics (anti-sickness). Painkillers which contain codeine and other 'opiates' should usually be avoided as they can increase sickness and are potentially addictive.

People who get frequent migraines (two or more attacks a month), or if headache treatment is not working, may be helped by long-term preventative treatments, such as daily beta-blocker tablets or other heart or blood pressure tablets, pizotifen, amitriptyline, or epilepsy treatments such as topiramate or sodium valproate. Vydura can also be used as a preventative treatment. Consult with your GP if you think a preventative migraine treatment may help you.

There is ongoing research into migraine treatments and some newer preventative treatments are available, usually only from specialist migraine doctors. These include botox injections, monoclonal antibody therapies - erenumab, fremanezumab, and galcanezumab, and magnetic and nerve stimulation techniques. Alternative therapies include acupuncture and various herbs (e.g. feverfew) and other supplements, from health food shops.