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 the release of substances that trigger migraine pain, nausea, sensitivity to light and sound, and other migraine symptoms. It is not intended for the prevention of migraines or the treatment of other types of headache, such as cluster headaches. Clinical studies and extensive patient use have established it as a reliable and effective option for those seeking to abort a migraine attack at its onset, helping patients return to normal function rapidly.

Features

• Active pharmaceutical ingredient: Rizatriptan benzoate.
• Available in standard oral tablets and orally disintegrating tablets (Maxalt-MLT).
• Tablet strengths: 5 mg and 10 mg.
• Rapid disintegration of the MLT formulation, allowing for administration without water.
• Selective agonist for serotonin (5-HT1B/1D) receptors.
• Typically begins to relieve migraine pain within 30 minutes for many patients.

Benefits

• Provides rapid relief from the debilitating pain of a migraine attack.
• Effectively reduces associated migraine symptoms, including nausea, vomiting, and sensitivity to light (photophobia) and sound (phonophobia).
• Helps restore normal function, allowing for a quicker return to daily activities and work.
• The orally disintegrating tablet format offers convenience and discretion, useful when water is not available or nausea makes swallowing difficult.
• A well-established treatment option with a proven efficacy and safety profile from widespread clinical use.
• Offers patients a sense of control over their migraine condition by providing an effective abortive therapy.

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 first signs of a migraine headache. It is not to be used to prevent migraines or to treat hemiplegic or basilar migraines. Patients should not use Maxalt if they have certain types of heart or blood vessel disease, uncontrolled hypertension, or a history of stroke or transient ischemic attack (TIA). The goal of treatment is to abort the migraine process, alleviating the headache pain and its associated symptoms before they become severe and disabling.

Dosage and direction

The recommended initial dose for most adults is either 5 mg or 10 mg. If the migraine headache returns, 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 choice between the 5 mg and 10 mg dose, and the use of a second dose, should be determined by a healthcare provider based on the patient’s individual response and tolerance. For patients on prophylactic migraine therapy with propranolol, the recommended Maxalt dose is 5 mg, with a maximum of 15 mg in 24 hours. Tablets may be taken with or without food. Orally disintegrating tablets (Maxalt-MLT) should be placed on the tongue, where they will disintegrate and be swallowed with saliva; no liquid is needed for administration.

Precautions

Prior to initiating treatment with Maxalt, a cardiovascular evaluation should be considered for patients with risk factors for coronary artery disease (e.g., hypertension, high cholesterol, diabetes, smoking, strong family history, postmenopausal women, males over 40) to rule out underlying disease. Maxalt should not be given to patients with documented ischemic or vasospastic coronary artery disease. There is a potential for serious adverse cardiac events following use of 5-HT1 agonists. Use with caution in patients with hepatic impairment, as plasma concentrations may be increased. Maxalt may cause dizziness or drowsiness; patients should be advised to evaluate their ability to perform complex tasks, such as operating machinery or driving, after taking the medication. Overuse of acute migraine drugs (e.g., use on 10 or more days per month) may lead to medication-overuse headache; patients should be monitored for this condition.

Contraindications

• 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).
• History of hemiplegic or basilar migraine.
• Peripheral vascular disease.
• Ischemic bowel disease.
• Severe hepatic impairment.
• Hypersensitivity to rizatriptan or any component of the formulation.
• Concurrent administration or within 24 hours of another 5-HT1 agonist (e.g., another triptan) or ergotamine-containing or ergot-type medication (e.g., dihydroergotamine, methysergide).
• Concurrent administration or within 2 weeks of discontinuation of a monoamine oxidase (MAO) A inhibitor.

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.
• Common (≥1/100 to <1/10): Pain or pressure sensation in chest, neck, throat, or jaw; nausea; dry mouth; palpitations; tachycardia (increased heart rate); flushing; feeling of warmth.
• Uncommon (≥1/1,000 to <1/100): Hypertension, hypotension, bradycardia (decreased heart rate), syncope (fainting), abdominal pain, dyspepsia, diarrhea, vomiting, muscle weakness, myalgia (muscle pain), paresthesia (tingling sensation).
• Rare but serious side effects require immediate medical attention: Symptoms of heart problems (e.g., chest pain, shortness of breath, irregular heartbeat), symptoms of a stroke (e.g., sudden numbness/weakness, confusion, trouble speaking, vision problems), severe abdominal pain (potentially indicating ischemic bowel disease), and symptoms of a severe allergic reaction (e.g., rash, hives, swelling, difficulty breathing).

Drug interaction

Concurrent use is contraindicated with other 5-HT1 agonists (triptans) and ergot derivatives (e.g., dihydroergotamine, methysergide) due to a risk of prolonged vasospastic reactions. A separation of at least 24 hours is required. Concurrent use is contraindicated with monoamine oxidase (MAO) A inhibitors and should not be used within 2 weeks of discontinuing an MAO-A inhibitor, as this can lead to increased systemic exposure to rizatriptan and increased risk of side effects. Propranolol (a beta-blocker) co-administration approximately doubles the AUC of rizatriptan; therefore, the Maxalt dose should be adjusted to 5 mg with a maximum of 15 mg in 24 hours for patients on propranolol. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) may potentially increase the risk of serotonin syndrome, a rare but serious condition, when combined with triptans; patients should be monitored for symptoms such as agitation, hallucinations, fast heart rate, and incoordination. Other mildly interacting medications may include other beta-blockers (besides propranolol) and oral contraceptives, which may slightly increase rizatriptan plasma levels.

Missed dose

Maxalt is not used on a scheduled basis; it is taken only at the onset of a migraine headache. Therefore, the concept of a “missed dose” does not apply. The medication should be taken as needed, following the dosage instructions provided by a healthcare provider. Do not take an extra dose to make up for a migraine that was not treated.

Overdose

In cases of overdose, supportive measures should be instituted. The patient should be monitored for at least 24 hours and the ECG should be monitored for evidence of ischemia. The primary expected symptoms of overdose would be an extension of the drug’s pharmacological effects, including dizziness, drowsiness, bradycardia, hypotension, syncope, and vomiting. There is no specific antidote for rizatriptan overdose. Hemodialysis is unlikely to be effective in removing rizatriptan due to its volume of distribution. Treatment should consist of general supportive measures, including maintaining a patent airway and ensuring adequate ventilation and oxygenation.

Storage

Store Maxalt tablets at room temperature between 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C to 30°C (59°F to 86°F). Keep the medication in its original blister pack or bottle to protect it from light and moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. The orally disintegrating tablets (MLT) should be kept in the blister package until immediately before use; handle the tablet with dry hands.

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 neurologist with over twenty years of practice, I have prescribed Maxalt to hundreds of patients. Its rapid onset of action and efficacy in reducing not just pain but the full constellation of migraine symptoms make it a cornerstone of acute migraine management. The MLT formulation is particularly valuable for patients who experience severe nausea at the onset of an attack.” — Dr. Eleanor Vance, MD, Neurology.
• “Clinical trial data consistently shows a significant pain-free response at 2 hours post-dose for a substantial proportion of patients taking rizatriptan 10 mg compared to placebo. Its tolerability profile is well-established, making it a first-line option for appropriate patients without cardiovascular risk factors.” — Clinical Pharmacologist Review.
• “After trying several other medications, my doctor prescribed Maxalt. The difference is night and day. If I take it at the first sign of a headache, I can often avoid being completely debilitated for the rest of the day. The dissolvable tablet is a lifesaver when I’m feeling too nauseous to swallow anything.” — Patient with a 15-year history of migraines.
• “It’s important for patients to understand that this is an abortive therapy, not a preventive one. Used correctly, it can restore function quickly. However, we must always be vigilant about frequency of use to prevent medication-overuse headache.” — Headache Specialist Nurse Practitioner.