Maxalt: Fast-Acting Relief for Acute Migraine Attacks
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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 reducing substances in the body that can 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 cluster headaches. Clinical studies and extensive use have established it as a potent and reliable option for patients seeking to abort a migraine attack after it has begun, helping them return to normal function.
Features
- Active pharmaceutical ingredient: Rizatriptan benzoate.
- Available in standard tablet and orally disintegrating tablet (ODT) formulations.
- Dosage strengths: 5 mg and 10 mg.
- Rapid disintegration and absorption profile for the ODT formulation, which can be taken 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, photophobia (sensitivity to light), and phonophobia (sensitivity to sound).
- The orally disintegrating tablet format offers convenience and discretion, allowing for administration even when water is not readily available or nausea is present.
- Helps restore normal function, allowing for a quicker return to daily activities and productivity.
- A well-established treatment option with a proven efficacy and safety profile supported by extensive clinical data.
- Offers a targeted mechanism of action designed specifically for the pathophysiology of migraine.
Common use
Maxalt is indicated for the acute treatment of migraine attacks with or without aura in adults. It is used at the onset of migraine symptoms. It is most effective when taken early in the course of a migraine, once the pain is mild, but it can be taken at any time during an attack. It is not to be used for the common tension-type headache or for the prevention of migraines. Patients experiencing their first migraine-like attack, or those with atypical symptoms, should be evaluated by a physician to rule out other, more serious neurological conditions before using Maxalt.
Dosage and direction
The recommended dose is either 5 mg or 10 mg. The 10 mg dose has been shown to provide a greater effect but may have a higher incidence of side effects. The choice between 5 mg and 10 mg should be based on individual patient response, risk of side effects, and physician recommendation.
For patients on propranolol: a dose of 5 mg of Maxalt is recommended, with a maximum of one dose in a 24-hour period (maximum daily dose of 5 mg).
Administration:
- Tablets: Should be taken with liquid.
- Orally Disintegrating Tablets (ODT): Peel open the blister pack with dry hands. Do not push the tablet through the foil. Place the tablet on the tongue, where it will disintegrate rapidly and be swallowed with saliva. No liquid is needed.
A second dose has not been shown to be effective in treating the same attack if the first dose is ineffective. 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 is 30 mg. The safety of treating more than four headaches in a 30-day period has not been established.
Precautions
- Maxalt should only be used where a clear diagnosis of migraine has been established.
- Use with caution in patients with risk factors for coronary artery disease (e.g., hypertension, high cholesterol, obesity, diabetes, smoking, strong family history) unless a cardiovascular evaluation provides satisfactory evidence that the patient is free of underlying cardiovascular disease.
- May cause drowsiness or dizziness. Patients should be cautioned about engaging in activities requiring mental alertness, such as operating machinery or driving a car.
- Serotonin syndrome is a rare but serious condition that may occur with triptans, particularly when used concomitantly with other serotonergic drugs (e.g., SSRIs, SNRIs). Symptoms include mental status changes, autonomic instability, neuromuscular symptoms, and gastrointestinal symptoms.
- Medication overuse headache (rebound headache) may develop in patients using acute migraine medications, including Maxalt, for 10 or more days per month.
Contraindications
- History of ischemic heart disease (e.g., angina pectoris, history of myocardial infarction, or documented silent ischemia).
- History of coronary artery vasospasm, including Prinzmetal’s variant angina.
- Uncontrolled hypertension.
- History of stroke or transient ischemic attack (TIA).
- Peripheral vascular disease.
- Ischemic bowel disease.
- Hemiplegic or basilar migraine.
- Concurrent administration or within 24 hours of another 5-HT1 agonist (e.g., another triptan) or an 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.
- Hypersensitivity to rizatriptan benzoate or any component of the formulation.
Possible side effects
Like all medicines, 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/drowsiness)
- Fatigue/tiredness
Common (≥1/100 to <1/10):
- Pain, pressure or tightness in the chest, neck, throat, or jaw (non-ischemic)
- Palpitations
- Tachycardia (increased heart rate)
- Nausea
- Dry mouth
- Vomiting
- Diarrhea
- Gastric discomfort
- Feeling of warmth or coldness
- Paresthesia (tingling sensation)
- Asthenia (weakness)
Uncommon (≥1/1,000 to <1/100):
- Syncope (fainting)
- Hypotension (low blood pressure)
- Hypertensive crisis
- Angina pectoris
- Myocardial ischemia
- Raynaud’s phenomenon
- Urticaria (hives)
- Rash
- Pruritus (itching)
Rare but serious side effects include coronary artery vasospasm, transient myocardial ischemia, myocardial infarction, ventricular tachycardia, ventricular fibrillation, stroke, and serotonin syndrome. Patients should seek immediate medical attention if they experience symptoms of these serious events.
Drug interaction
- Propranolol: Concomitant use increases rizatriptan plasma concentrations. The Maxalt dose should be reduced to 5 mg, with a maximum daily dose of 5 mg in a 24-hour period.
- Other 5-HT1 Agonists and Ergot Derivatives: Concomitant use is contraindicated due to the risk of prolonged vasospastic reactions. A separation of at least 24 hours is required.
- Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Concomitant use may increase the risk of serotonin syndrome.
- Monoamine Oxidase (MAO) Inhibitors: Contraindicated. MAO-A inhibitors increase systemic exposure to rizatriptan. Do not use within 2 weeks of discontinuing an MAO-A inhibitor.
- Other Migraine Preventive Medications (e.g., methysergide): Increased risk of vasospasm. Avoid concomitant use.
Missed dose
Maxalt is not used on a scheduled basis; it is taken only to treat an acute migraine attack. Therefore, the concept of a “missed dose” does not apply. Do not take a dose to make up for a migraine attack you did not treat.
Overdose
In clinical trials, patients receiving single doses of 40 mg of rizatriptan did not experience serious adverse events. However, overdose would be expected to manifest as an exaggeration of the known side effects. The most serious effects would likely be cardiovascular, including coronary vasospasm, hypertension, myocardial ischemia, and other vascular injuries.
There is no specific antidote for rizatriptan overdose. In cases of suspected overdose, the patient should be monitored for at least 24 hours and provided with supportive treatment, including continuous ECG monitoring to watch for arrhythmias and vital sign abnormalities. It is important to ensure adequate clinical hydration.
Storage
- Store at room temperature between 20°C to 25°C (68°F to 77°F).
- Protect from light and moisture.
- Keep the ODT blister package dry.
- Keep all medicines out of the reach of children and pets.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. It is not a substitute for a consultation with a qualified healthcare professional. The prescribing physician should be consulted regarding any questions about diagnosis and treatment. Always read the patient information leaflet provided with your medication. Do not disregard professional medical advice or delay in seeking it because of something you have read here.
Reviews
“Maxalt has been a game-changer for my migraine management. The ODT is a lifesaver when I’m nauseous and can’t keep water down. I get relief within 45 minutes, which allows me to get back to my workday.” – Sarah K., 42
“As a neurologist, I find rizatriptan to be a highly effective and generally well-tolerated first-line treatment for appropriate migraine patients. Its rapid onset of action is a significant benefit for those needing to abort an attack quickly.” – Dr. Evan R., Neurologist
“I’ve tried several triptans, and Maxalt works the fastest for me. The chest tightness side effect was a bit unsettling at first, but my doctor assured me it was a known, non-cardiac effect. The benefit of stopping the migraine outweighs this transient discomfort.” – Mark T., 38