Rizatriptan

In this section
Does it work?
What is it?
How can it help?
Why should it work?
Can it be harmful?
What's the evidence?

Does it work?

Yes. Rizatriptan can make you feel better. About 7 in 10 people find their symptoms improve when they take rizatriptan.¹ Even if your headache is very bad, taking rizatriptan should make the pain milder and more bearable. It may also make you less likely to get another attack within 24 hours.

Rizatriptan also helps with the nausea and vomiting some people get with a migraine attack.

What is it?

Rizatriptan is a type of drug known as a triptan. It works in a way that is similar to a chemical in your brain called serotonin. Like serotonin, triptans make the blood vessels in your brain narrower. And this can stop your brain feeling the pain of an attack, at least partly.

The brand name is Maxalt. It comes as tablets and also as wafers or special tablets that dissolve in your mouth.

How can it help?

Rizatriptan can help you get rid of a migraine attack within two hours.^{1 2 3}

• This medicine should make your attack better even if your pain is very bad.
• It helps 6 in 10 to 7 in 10 people who take it.
• Rizatriptan can also help if your attack makes you feel extra-sensitive to lights and noise. And 1 in 2 people who take it will be able to get back to their normal routine within two to four hours.
• Taking rizatriptan can also mean you'll be less likely to need other painkillers or that your attack will come back within 24 hours.
• Rizatriptan can also relieve symptoms like nausea and vomiting.
• Taking the higher dose of 10 milligrams (mg) seems to work a bit better than taking a dose of 5 mg.

A study looking at all the triptans available at the time (in 2007) found that they all helped to get rid of the pain within two hours, or make it much milder, compared to a dummy drug (a placebo). But only sumatriptan and rizatriptan worked better than a placebo drug within half an hour.⁴

Why should it work?

Like other triptans, rizatriptan acts like a chemical in your brain called serotonin. It binds to your cells at specific sites called serotonin receptors, rather like a key being put into a lock.

Rizatriptan helps to treat migraine attacks in three main ways.

• When you have an attack, the blood vessels in your brain open up (dilate). This means there is more blood flowing through them. Researchers think this is what causes the pain. Rizatriptan corrects the changes in blood flow and makes your blood vessels narrower.
• Secondly, it blocks nerves from releasing chemicals that cause blood vessels in the brain to open up.
• Thirdly, it blocks the release of chemicals that carry pain messages between different parts of the brain.

All of these effects work together to help you feel better.

Can it be harmful?

Like all triptan drugs, rizatriptan can have side effects although they are usually mild and do not last long.¹

• The most common side effects are pins and needles and feelings of warmth in different parts of your body.
• This medicine can also make you feel dizzy or flushed or get neck pain and stiffness.
• You can get more worrying side effects like feeling confused and drowsy but these are less common.
• Some people get chest pain or tightness but this is not very common.

If you take a higher dose of rizatriptan, you are a bit more likely to get side effects than if you take a lower dose. With the 10 mg dose, for example, there is a higher chance of getting chest symptoms and drowsiness than with the 5 mg dose.¹ Also the 10 mg dose of rizatriptan causes more side effects than another triptan drug called naratriptan.

But it's not clear from the research what proportion of people get side effects. Different studies say different things. And in many studies, people taking a dummy treatment (a placebo) also got side effects. So it may not always be rizatriptan that is causing the problems.

One study we looked at found that more than one-third of people taking 10 mg of rizatriptan got side effects.³ The most common ones were:

• Dizziness (about 7 in 100 people got this)
• Nausea (more than 4 in 100 people got this)
• Drowsiness (about 5 in 100 people got this).

Another study found that 2 in 100 people taking 10 mg of rizatriptan got chest pain (compared to 1 in 100 taking a placebo) and 5 in 100 felt low on energy.²

If you have heart disease, you should not take this medicine. It can make your blood vessels narrower and your heart disease worse. If you have risk factors for heart disease, like high blood pressure, your doctor might want you to take some heart tests before using this medicine to see if it is safe for you.⁵

Triptans and antidepressants

If you take rizatriptan (or any other triptan) together with one of the groups of medicines called selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-noradrenaline reuptake inhibitors (SNRIs), there's a chance you could get a condition called serotonin syndrome.⁶ SSRIs and SNRIs are types of antidepressants. They are treatments for depression and some other mental health problems. SNRIs are sometimes called selective serotonin-norepinephrine reuptake inhibitors.

Serotonin syndrome happens when you get too much serotonin in your body. It can be fatal. All SSRIs and SNRIs increase the amount of serotonin in the body. Names (and brand names) of SSRIs and SNRIs include:

• citalopram (Cipramil)
• duloxetine (Cymbalta)
• escitalopram (Cipralex)
• fluovoxamine (Faverin)
• fluoxetine (Prozac)
• paroxetine (Seroxat)
• sertraline (Lustral)
• venlafaxine (Effexor).

The symptoms of serotonin syndrome are:

• Feeling restless
• Rapid changes in blood pressure (you may not notice anything when this happens)
• A rise in your body temperature
• Feeling jittery
• Feeling like you might be sick
• Vomiting
• Diarrhoea.

The chances of getting serotonin syndrome are highest when you start treatment with one of these medicines in addition to one you're already taking, or the dose of one of them is increased.

If you get any of the above symptoms you should see your doctor or go to an emergency department straight away.

What's the evidence?

What's the evidence for rizatriptan?