Rizact is a prescription medication specifically formulated for the acute treatment of migraine attacks with or without aura in adults. It is not intended for the prophylactic management of migraine. Containing the active ingredient rizatriptan benzoate, a selective serotonin (5-HT1B/1D) receptor agonist, Rizact works by constricting dilated blood vessels in the brain and inhibiting the release of pro-inflammatory neuropeptides, thereby addressing the complex pathophysiology of a migraine attack. This product card provides a comprehensive, expert-level overview for healthcare professionals to aid in patient counseling and clinical decision-making.

Features

• Active Ingredient: Rizatriptan Benzoate (equivalent to 5 mg or 10 mg rizatriptan base)
• Dosage Form: Orally disintegrating tablet (ODT)
• Pharmacologic Class: Selective 5-hydroxytryptamine1B/1D (5-HT1B/1D) receptor agonist (triptan)
• Mechanism of Action: Binds with high affinity to 5-HT1B/1D receptors, causing cranial vasoconstriction and inhibition of trigeminal nerve pathway activation
• Rapid Administration: Orally disintegrating formulation allows for administration without water, beneficial for nausea associated with migraine
• Bioavailability: Approximately 45%, with peak plasma concentrations (Tmax) reached within 1-1.5 hours
• Half-life: Mean elimination half-life is 2-3 hours

Benefits

• Provides rapid relief from the debilitating pain, photophobia, phonophobia, and nausea associated with acute migraine attacks.
• The orally disintegrating tablet format offers a significant advantage for patients experiencing severe nausea or vomiting, facilitating easier administration.
• Demonstrates high efficacy in achieving pain freedom and resolution of the most bothersome migraine-associated symptom within 2 hours post-dose.
• Offers a favorable consistency of response, with many patients experiencing relief across multiple migraine attacks.
• Helps restore normal function, allowing patients to resume daily activities more quickly compared to untreated attacks.
• Provides a targeted therapeutic approach that acts on the specific pathophysiological mechanisms of migraine, unlike non-specific analgesics.

Common use

Rizact is indicated for the acute treatment of migraine with or without aura in adults. It is most effective when administered during the early stages of a migraine attack, as soon as the patient recognizes the migraine symptoms. It is not indicated for the prevention of migraines or for the treatment of cluster headaches. Clinical use is based on a confirmed diagnosis of migraine. It should not be used in patients with hemiplegic or basilar migraine.

Dosage and direction

The recommended dose is either 5 mg or 10 mg. For most patients, the recommended initial dose is 10 mg. A 5 mg dose may be suitable for patients on propranolol or those who experience significant side effects. If the migraine 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 tablet should be placed on the tongue, where it will disintegrate within seconds and be swallowed with saliva. No liquid is needed for administration.

Precautions

Rizact may cause coronary vasospasm; it is contraindicated in patients with ischemic heart disease or symptoms consistent with ischemic heart disease. It may cause increases in blood pressure, including hypertensive crises. Cerebrovascular events, including stroke and hemorrhage, have been reported. Peripheral vascular ischemia and colonic ischemia have occurred. Medication overuse headache may develop in patients using triptans for 10 or more days per month. Carefully evaluate patients for cardiovascular risk factors (e.g., hypertension, hypercholesterolemia, smoking, obesity, diabetes, strong family history, postmenopausal women, males over 40) before prescribing. Use with caution in patients with hepatic impairment. Not recommended for patients with severe renal impairment.

Contraindications

• Ischemic heart disease (e.g., angina pectoris, history of myocardial infarction, 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 another 5-HT1 agonist (e.g., another triptan) or ergotamine-containing medication
• Concurrent administration or within 2 weeks of discontinuation of MAO-A inhibitors

Possible side effect

Common side effects (≥5% and greater than placebo) include:

• Asthenia/fatigue
• Dizziness
• Somnolence (drowsiness)
• Pain/pressure sensations (e.g., chest, neck, throat, jaw) – often non-cardiac in origin but require evaluation
• Nausea

Less common but serious side effects require immediate medical attention:

• Symptoms of angina, myocardial infarction, or arrhythmia (chest pain, shortness of breath, irregular heartbeat)
• Symptoms of cerebrovascular events (sudden numbness/weakness, severe headache, confusion, vision/speech problems)
• Symptoms of serotonin syndrome (agitation, hallucinations, fever, tachycardia, nausea/vomiting, muscle rigidity)
• Significant hypertension
• Gastrointestinal ischemic events (abdominal pain, bloody diarrhea)
• Seizures

Drug interaction

• Monoamine Oxidase-A Inhibitors: Contraindicated. Markedly increases rizatriptan plasma concentrations.
• Propranolol: Increases rizatriptan plasma AUC by 70%. The dose of Rizact should be reduced to 5 mg, with a maximum of 15 mg in 24 hours.
• Other 5-HT1 Agonists (Triptans) and Ergot Derivatives: Contraindicated due to additive vasoconstrictive effects.
• Selective Serotonin Reuptake Inhibitors (SSRIs)/Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Potential increased risk of serotonin syndrome.
• Other highly protein-bound drugs: Theoretical potential for interaction, but clinical significance is unknown.

Missed dose

Rizact is taken on an as-needed basis for acute migraine attacks; it is not taken on a scheduled regimen. Therefore, the concept of a “missed dose” does not apply. The medication should be taken at the onset of migraine symptoms. If a dose is not taken and the migraine progresses, the medication may be less effective but can still be administered.

Overdose

Overdose may lead to an exaggeration of its known pharmacological effects. Symptoms could include severe dizziness, sedation, syncope, ventricular tachycardia, cardiac arrest, and hypertension. There is no specific antidote. Treatment consists of supportive measures, including continuous ECG monitoring for at least 20 hours, and management of symptoms. Hemodialysis is unlikely to be beneficial due to high protein binding.

Storage

Store at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C and 30°C (59°F and 86°F). Keep the blister package within the outer carton to protect from moisture and light. Keep out of reach of children. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is intended for educational purposes and for use by healthcare professionals. It 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 full official prescribing information should be consulted before prescribing Rizact.

Reviews

Clinical studies have demonstrated that a 10 mg dose of rizatriptan provided pain relief at 2 hours in up to 77% of patients, with pain freedom achieved in up to 42% of patients. The orally disintegrating formulation has been rated as convenient and preferable by a significant majority of patients in usability studies, particularly those who experience nausea. Consistent with its class, its efficacy is well-established in the acute treatment of moderate-to-severe migraine attacks.