A triptan migraine medicine
Rizatriptan
A fast-acting triptan taken at the start of a migraine attack, including as a melt-in-the-mouth wafer for when you feel sick.
What is Rizatriptan?
Rizatriptan is a triptan used to treat migraine attacks once the headache has begun. It is known for working quickly and comes as a wafer that melts on the tongue, which helps when nausea makes swallowing difficult. It treats attacks rather than preventing them, and people taking propranolol need a lower-than-usual dose.
Education and reference only. This is a plain-language guide to Rizatriptan — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Rizatriptan is a triptan widely used in the UK to treat migraine attacks. It is valued for its relatively fast onset and is taken when a migraine headache has already started. As well as ordinary tablets, it comes as an orodispersible wafer that melts on the tongue without water, which is helpful when a migraine brings on nausea or vomiting. Like other triptans it treats individual attacks and is not used to prevent them.
How it works
Rizatriptan acts on serotonin (5-HT) receptors involved in migraine. It narrows the blood vessels around the brain that widen during an attack and damps down the release of inflammatory, pain-signalling chemicals from nerves. The result is that the migraine process is interrupted and the attack settles more quickly. Because it targets the migraine mechanism, it is more effective than ordinary painkillers and works best taken early.
Company & origin
Originated / developed by: Merck & Co..
Developed by Merck & Co. in the United States and introduced around the late 1990s as a fast-acting triptan, also available as a melt-in-the-mouth wafer.
What it treats
Conditions Rizatriptan is used for
Practical use
How to take Rizatriptan
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it as soon as the migraine headache starts, not during the aura and not to prevent attacks.
- Let the wafer melt on the tongue with no water, or swallow ordinary tablets with water.
- If you take propranolol, you will be advised to use a lower dose and leave a longer gap — follow that advice.
- If the migraine returns after improving, a repeat dose may be taken after the recommended interval, without exceeding the daily maximum.
- Do not take it within 24 hours of another triptan or an ergotamine-type medicine.
- Limit the number of days each month you use it to reduce the chance of rebound headache.
Weighing it up
Advantages & disadvantages of Rizatriptan
Advantages
- Works relatively quickly compared with some other triptans.
- Melt-on-the-tongue wafer suits people who feel sick or cannot swallow during an attack.
- Treats the pain and the associated nausea and light/sound sensitivity together.
- Can be repeated within an attack if the migraine comes back, within daily limits.
Disadvantages
- Needs a reduced dose and longer interval if you also take propranolol.
- Only treats attacks once started — it does not prevent migraine.
- Can cause chest or throat tightness, tingling and drowsiness.
- Overuse can lead to medication-overuse (rebound) headache.
Practical use
Good to know
Rizatriptan is taken at the start of the migraine headache, not during the aura and not as a preventer. The melt wafer is handy when nausea is part of the attack, as it needs no water. Importantly, people who also take propranolol (a beta-blocker often used to prevent migraine or for blood pressure) need a reduced rizatriptan dose and a longer gap between taking the two, so always flag this. As with all triptans, using it on too many days a month risks medication-overuse headache.
Who should not take it / use with caution
- People with heart disease, angina, a previous heart attack or stroke, or narrowed blood vessels.
- People with uncontrolled or markedly raised high blood pressure.
- Anyone who has taken another triptan or an ergotamine within the past 24 hours.
- People taking certain MAOI antidepressants — check with a pharmacist or prescriber first.
- Tell your prescriber if you are pregnant, planning pregnancy or breastfeeding, as triptans are generally avoided or used with caution then.
Monitoring
- Blood pressure and heart-health risk should be checked before triptans are started.
- Keep a note of how many days a month migraine medicines are used.
- Report chest tightness, a very fast heartbeat or any new neurological symptoms.
Side effects
- Tingling, warmth or a tight, heavy feeling in the chest, throat, neck or jaw — usually brief.
- Drowsiness, dizziness, tiredness or dry mouth.
- Nausea, although it also helps the sickness of the migraine itself.
- Rarely, serotonin syndrome (agitation, sweating, shivering, fast heartbeat) with certain antidepressants — seek urgent advice.
Key interactions
- Propranolol increases rizatriptan levels, so a lower dose and longer gap are needed.
- Other triptans and ergotamine medicines — do not combine or use within 24 hours of each other.
- SSRI and SNRI antidepressants raise the small risk of serotonin syndrome.
- MAOI antidepressants — rizatriptan is generally avoided around their use.
Available as: Ordinary tablets and orodispersible wafers that melt on the tongue.
Answers
Rizatriptan: frequently asked questions
Why is rizatriptan different if I take propranolol?
Propranolol raises the level of rizatriptan in the body, so a lower dose and a longer gap between the two are recommended. Always tell your prescriber and pharmacist if you take propranolol.
Do I need water to take the wafer?
No. The orodispersible wafer melts on your tongue without water, which makes it useful when a migraine makes you feel sick or you cannot easily drink.
When in a migraine should I take it?
Take it as soon as the headache phase begins. It is not effective during the aura beforehand and is not a preventive medicine.
Can I repeat the dose if my migraine comes back?
Yes, usually after the recommended interval, provided you stay within the daily maximum. If the first dose had no effect at all, do not repeat it for the same attack.
Can frequent use cause more headaches?
Yes. Like all triptans and painkillers, using it on too many days a month can cause medication-overuse headache. Ask about prevention if you are using it often.
The wider class
About Triptans
Rizatriptan belongs to the triptans class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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