Maxalt

Maxalt (rizatriptan benzoate) is a prescription medication specifically formulated for the acute treatment of migraine attacks 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 reducing substances that trigger migraine pain, nausea, sensitivity to light and sound. This medication is designed to target the complex pathophysiology of a migraine, offering a targeted approach to alleviate debilitating symptoms and restore normal function. It is not intended for the prevention of migraines or the treatment of cluster headaches, and its use should be guided by a thorough neurological diagnosis.

Features

• Active Ingredient: Rizatriptan benzoate
• Available Formulations: Standard oral tablets and orally disintegrating tablets (Maxalt-MLT)
• Standard Strengths: 5 mg and 10 mg tablets
• Rapid Disintegration: Orally disintegrating tablet formulation dissolves on the tongue without the need for water
• Selective Mechanism: Binds selectively to serotonin (5-HT1B/1D) receptors
• Onset of Action: Designed for absorption and relief soon after administration

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).
• Helps restore normal function, allowing for a return to daily activities and productivity.
• The orally disintegrating tablet format offers convenience and ease of administration, even when nausea is present or water is unavailable.
• Offers a proven, targeted therapeutic option for patients with a confirmed migraine diagnosis.

Common use

Maxalt is indicated for the acute treatment of migraine attacks with or without aura in adults. It is most effective when taken at the very onset of migraine symptoms. It is not to be used for the management of hemiplegic or basilar migraines. Patients should not use this medication for more than four headaches in any 30-day period, as this may indicate an underlying medication-overuse headache condition requiring different management strategies. A migraine is a complex neurological event, and the use of a triptan like rizatriptan should be part of a comprehensive treatment plan developed with a healthcare provider.

Dosage and direction

The recommended dose is either 5 mg or 10 mg. For most patients, the 10 mg dose is the preferred starting dose, although a 5 mg dose may be recommended for patients on propranolol or those with hepatic impairment. A single dose should be taken as soon as the migraine symptoms begin. If the headache returns or there is only a partial response, a second dose may be taken at least 2 hours after the first dose. The maximum dose in a 24-hour period should not exceed 30 mg. The orally disintegrating tablet (MLT) should be placed on the tongue, where it will dissolve and be swallowed with saliva. No water is needed for this formulation. Tablets can be taken with or without food.

Precautions

Prior to using Maxalt, a cardiovascular evaluation is recommended for patients with risk factors for coronary artery disease (e.g., hypertension, high cholesterol, smoking, obesity, diabetes, strong family history) to rule out unrecognized heart disease. Use is associated with a small risk of serious cardiovascular events, including myocardial infarction and stroke. This medication may cause dizziness or drowsiness; patients should not drive or operate machinery until they know how it affects them. Caution is advised in patients with hepatic or renal impairment, as dosage adjustment may be necessary. Maxalt should only be used where a clear diagnosis of migraine has been established.

Contraindications

Maxalt is contraindicated in patients with:

• Ischemic heart disease (e.g., angina pectoris, history of myocardial infarction, or documented silent ischemia)
• History of coronary artery vasospasm, including Prinzmetal’s angina
• Uncontrolled 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 24 hours of use of another 5-HT1 agonist (e.g., another triptan) or ergotamine-containing medication
• Within 2 weeks of discontinuing an MAO-A inhibitor

Possible side effect

Like all medications, Maxalt can cause side effects, although not everybody gets them. Common side effects may include:

• Dizziness
• Drowsiness/sedation
• Fatigue or tiredness
• Pain or pressure sensation in the chest, neck, throat, or jaw (non-cardiac)
• Nausea
• Dry mouth Less common but more serious side effects require immediate medical attention:
• Signs of a heart attack: chest pain, shortness of breath, irregular heartbeat, pain spreading to the jaw or shoulder
• Signs of a stroke: sudden numbness or weakness, confusion, trouble speaking, vision problems
• Signs of serotonin syndrome: agitation, hallucinations, fever, fast heart rate, muscle stiffness, loss of coordination
• Severe stomach pain or bloody diarrhea
• Significant rise in blood pressure

Drug interaction

Maxalt has several important drug interactions that must be avoided:

• Other Triptans and Ergot Derivatives (e.g., ergotamine, dihydroergotamine): Concurrent use is contraindicated due to a prolonged vasoconstrictive reaction. A 24-hour separation is required.
• Monoamine Oxidase-A Inhibitors (MAOIs): Concurrent use or use within 2 weeks of stopping an MAOI is contraindicated. MAOIs can significantly increase rizatriptan plasma levels.
• Propranolol: Co-administration increases the plasma concentration of rizatriptan. The recommended dose of Maxalt is 5 mg, with a maximum of 3 doses in 24 hours (15 mg total) for patients taking propranolol.
• Selective Serotonin Reuptake Inhibitors (SSRIs) or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Concomitant use may potentially increase the risk of serotonin syndrome, a rare but serious condition.
• Other medications that affect serotonin levels should be used with caution.

Missed dose

Maxalt is not taken on a scheduled basis; it is used only to treat an acute migraine attack. Therefore, the concept of a “missed dose” does not apply. You take one dose at the onset of a migraine. If you do not take it and the migraine persists, you may take a dose at that time, following the same dosing rules (e.g., waiting at least 2 hours if you had taken a previous dose for a different headache).

Overdose

In cases of overdose, symptoms could include severe dizziness, drowsiness, fainting, slow heart rate, vomiting, and loss of coordination. The effects of an overdose could be potentiated by concomitant use of propranolol. There is no specific antidote for rizatriptan overdose. Treatment consists of supportive care, including continuous ECG monitoring for at least 24 hours and management of symptoms. In case of suspected overdose, contact a Poison Control Center (1-800-222-1222) or seek emergency medical attention immediately.

Storage

Store Maxalt tablets 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). Keep the medication in its original blister pack or bottle to protect it from light and moisture. Keep all medications out of the reach of children and pets. Do not flush medications down the toilet or pour them down a drain unless instructed to do so. Properly discard any expired or no-longer-needed medication through a medicine take-back program.

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 MLT version is a lifesaver when I’m nauseous and can’t keep water down. It typically aborts my migraine within 45-60 minutes, allowing me to function again.” – Sarah T., verified patient.
• “My neurologist prescribed Maxalt after other medications failed. The 10mg dose provides consistent relief from the debilitating pain and light sensitivity. I experience mild drowsiness afterward, but it’s a worthwhile trade-off for the relief.” – Mark D., verified patient.
• “Effective but use with caution. It works very well for my severe migraines. However, I did experience the chest tightness sensation once, which was frightening. I reported it to my doctor, and we discussed the risks. I still use it but am very mindful.” – Jennifer L., verified patient.
• “The speed of relief is impressive. I keep a dose in my desk at work. Taking it at the first sign of an aura usually stops the full migraine from developing. It has significantly reduced my sick days.” – David K., verified patient.