Discontinue the SSRI and rizatriptan and initiate symptomatic treatment if serotonin syndrome occurs. Dextromethorphan; Guaifenesin: (Moderate) Dextromethorphan inhibits serotonin reuptake and therefore should be used cautiously with serotonin-receptor agonists as serotonin syndrome may result. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome particularly during treatment initiation and dose increases. Serotonin syndrome may occur within recommended dose ranges. -Initial dose: 10 mg orally once The AUC of the active N-monodesmethyl metabolite was not affected by propranolol. We do not record any personal information entered above. Patients receiving serotonergic drugs in combination should be informed of the signs and symptoms of serotonin syndrome. ergotamine, triptans, opioids) for 10 or more days per month consider withdrawal of the overused drugs and treatment of withdrawal symptoms. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. Serotonin syndrome may occur within recommended dose ranges. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome. Food does not affect the availability of rizatriptan but delays the time to peak concentration by an hour and increases AUC. Serotonin syndrome may occur within recommended dose ranges. Sumatriptan: (Severe) Rizatriptan is contraindicated for use within 24 hours of treatment with sumatriptan due to the risk for additive vasospastic reactions. This interaction requires a dose adjustment of rizatriptan when it is given concurrently with propranolol. Patients who are long-term users of rizatriptan and who have or acquire risk factors predictive of CAD should undergo periodic cardiac evaluation. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome. Rizatriptan is metabolized via oxidative deamination by monoamine oxidase-A (MAO-A) to the inactive indoleacetic acid metabolite and to a small degree, to N-monodesmethyl-rizatriptan which has similar activity as the parent compound. Serotonin syndrome can be serious and consists of symptoms such as mental status changes, diaphoresis, tremor, myoclonus, hyperreflexia, and fever. How to use Rizatriptan Benzoate? Symptoms may occur hours to days after concomitant use, particularly after dose increases. Since rizatriptan is used as needed, it does not have a daily dosing schedule. Serotonin syndrome can be serious and consists of symptoms such as mental status changes, diaphoresis, tremor, myoclonus, hyperreflexia, and fever. Some patients had used the combination previously without incident when serotonin syndrome occurred. Methylene Blue: (Major) Theoretically, concurrent use of methylene blue and serotonin-receptor agonists may increase the risk of serotonin syndrome. Consider the developmental and health benefits of breast-feeding along with the mother's clinical need for rizatriptan and any potential adverse effects on the breast-fed infant from rizatriptan or the underlying maternal condition. Isocarboxazid: (Severe) The administration of rizatriptan to patients currently receiving a monoamine oxidase A inhibitor or within 2 weeks of discontinuing a monoamine oxidase A inhibitor is contraindicated. Discontinue all serotonergic agents if serotonin syndrome occurs and implement appropriate medical management. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome. Acetaminophen; Dextromethorphan; Phenylephrine: (Moderate) Dextromethorphan inhibits serotonin reuptake and therefore should be used cautiously with serotonin-receptor agonists as serotonin syndrome may result. It is thought that the interaction between SNRIs or SSRIs and serotonin-receptor agonists is the result of increased serotonergic activity by each of the drug classes. MAXALT ® rizatriptan benzoate tablets . Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, and coma), autonomic instability (e.g., tachycardia, labile blood pressure, and hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination) and/or gastrointestinal symptoms (e.g., nausea, vomiting, and diarrhea). Patients receiving serotonergic drugs in combination should be informed of the signs and symptoms of serotonin syndrome. Diphenhydramine; Hydrocodone; Phenylephrine: (Moderate) Serotonin syndrome can occur during concomitant use of opiate agonists with serotonergic drugs, such as serotonin-receptor agonists. Consult WARNINGS section for additional precautions. During a drug interaction study with meclobemide, the mean increase in rizatriptan Cmax was 41%, and the mean increases in the AUC of rizatriptan and its metabolite were 119% and 400%, respectively. Patients receiving serotonergic drugs in combination should be informed of the signs and symptoms of serotonin syndrome. Symptoms may occur hours to days after concomitant use, particularly after dose increases. Serotonin syndrome has been reported during concurrent use of serotonin-receptor agonists and serotonin norepinephrine reuptake inhibitors. Symptoms may occur hours to days after concomitant use, particularly after dose increases. Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate: (Major) Theoretically, concurrent use of methylene blue and serotonin-receptor agonists may increase the risk of serotonin syndrome. Whenever possible, these drug combinations should be avoided. Brompheniramine; Dextromethorphan; Guaifenesin: (Moderate) Dextromethorphan inhibits serotonin reuptake and therefore should be used cautiously with serotonin-receptor agonists as serotonin syndrome may result. Active Ingredient(s) RIZATRIPTAN BENZOATE 10 mg/1 ; Pharmacological Class(es) Common side effects include chest pain, dizziness, dry mouth, and tingling. Serotonin syndrome may occur within recommended dose ranges. rizatriptan benzoate is a potent and selective 5-hydroxytryptamine 1B/1D receptor agonist and is considered more effective than the traditional triptans for the treatment of acute migraine attack[1]. Nefazodone: (Major) Medications that augment release, decrease the metabolism of, or decrease the reuptake of serotonin, like the serotonin-receptor agonists, may interact with nefazodone by causing serotonin-related side effects, including serotonin syndrome. While stroke, cerebral hemorrhage, and related fatalities have been reported following administration of 5-HT1 agonists, these events may have been present prior to administration of the drug, and the drug was mistakenly given in response to the cerebrovascular symptoms. Symptoms may occur hours to days after concomitant use, particularly after dose increases. Trimipramine: (Moderate) Tricyclic antidepressants (TCAs) should be used cautiously with drugs that also augment serotonin, like the serotonin-receptor agonists ("triptans") used for the treatment of migraine. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome. The rizatriptan prospective pregnancy registry did not identify any pattern of congenital anomalies or other adverse birth outcomes over 20 years. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. Serotonin syndrome may occur within recommended dose ranges. Serotonin syndrome may occur within recommended dose ranges. Preparation of the standard solution: Standard stock solution of Rizatriptan benzoate was prepared by transferring 10 mg of Rizatriptan benzoate into10ml volumetric flasks separately; it was dissolved and diluted to the mark with methanol to obtain standard solutions containing 1000µg/ml. Patients receiving concomitant administration of other antimigraine agents (e.g., beta-blockers including propranolol) with rizatriptan had similar adverse reaction rates as compared to those who did not receive these medications concomitantly. Methylene blue is a thiazine dye that is also a potent, reversible inhibitor of the enzyme responsible for the catabolism of serotonin in the brain (MAO-A) and serotonin-receptor agonists increase central serotonin effects. Serotonin syndrome can be serious and consists of symptoms such as mental status changes, diaphoresis, tremor, myoclonus, hyperreflexia, and fever. Serotonin syndrome is characterized by rapid development of various symptoms such as hyperthermia, hypertension, myoclonus, rigidity, hyperhidrosis, incoordination, diarrhea, mental status changes (e.g., confusion, delirium, or coma), and in rare cases, death. -History of stroke or transient ischemic attacks Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome. Serious CNS reactions, such as serotonin syndrome, have been reported during the concurrent use of linezolid, which is structurally similar to tedizolid, and psychiatric medications that enhance central serotonergic activity; therefore, caution is warranted with concomitant use of other agents with serotonergic activity. Rizatriptan is principally metabolized by monoamine oxidase A (MAO-A); therefore, plasma concentrations of rizatriptan may be increased by concurrent use of selective MAO-A inhibitors (e.g., meclobemide) or non-selective MAO-A and MAO-B inhibitors (e.g., phenelzine, tranylcypromine, isocarboxazid) and rizatriptan. ECG monitoring is strongly encouraged due to the possibility of asymptomatic cardiac ischemia during the time immediately following rizatriptan administration in patients with risk factors. According to the manufacturer, no interaction is expected between rizatriptan and selective MAO-B inhibitors. Tricyclic antidepressants inhibit norepinephrine and serotonin uptake, but rarely cause serotonin syndrome when used alone. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. • Safety and effectiveness of rizatriptan benzoate tablets have not been established for cluster headache. Serotonin syndrome has been reported during concurrent use of serotonin-receptor agonists and SSRIs. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome particularly during treatment initiation and dose increases. Serotonin syndrome may occur within recommended dose ranges. 10 mg PO as a single dose. Droxidopa: (Major) Coadministration of droxidopa with other agents that increase blood pressure, such as serotonin-receptor agonists, would be expected to increase the risk for supine hypertension. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome particularly after a dose increase of the SSRI or the addition of other serotonergic medications to an existing SSRI regimen. Serotonin syndrome is characterized by rapid development of various symptoms such as hyperthermia, hypertension, myoclonus, rigidity, hyperhidrosis, incoordination, diarrhea, mental status changes (e.g., confusion, delirium, or coma), and in rare cases, death. Tricyclic antidepressants inhibit norepinephrine and serotonin uptake, but rarely cause serotonin syndrome when used alone. 6 years or older and weight less than 40 kg: Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome particularly after a dose increase of the SSRI or the addition of other serotonergic medications to an existing SSRI regimen. Not a Member? However, it should be noted that selegiline, a selective MAO-B inhibitor, may interact with rizatriptan at higher doses (> 20 mg) since the MAO-B selectivity of the drug diminishes at higher doses. However, the risk may be increased when combined with other serotonergic agents, especially at times of antidepressant dose increases. Rizatriptan belongs to a class of drugs known as triptans. Ergot alkaloids have been reported to cause prolonged vasospastic reactions which may be additive with the effects of triptans. If your symptoms are only partly relieved, or if your headache comes back, adults may take another dose at least 2 hours after the first dose. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome. Additive serotonergic effects, including serotonin syndrome, may also occur. Patients receiving serotonergic drugs in combination should be informed of the signs and symptoms of serotonin syndrome. What are the side effects for Rizatriptan Benzoate? Serotonin syndrome can be serious and consists of symptoms such as mental status changes, diaphoresis, tremor, myoclonus, hyperreflexia, and fever. Serotonin syndrome has been reported during concurrent use of serotonin-receptor agonists and serotonin norepinephrine reuptake inhibitors. 3. Migraine Therapy . Patients receiving serotonergic drugs in combination should be informed of the signs and symptoms of serotonin syndrome. Serotonin syndrome has been reported during concurrent use of serotonin-receptor agonists and SSRIs. Orally Disintegrating Tablets (ODT): You should confirm the information on the PDR.net site through independent sources and seek other professional guidance in all treatment and diagnosis decisions. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. Some patients had used the combination previously without incident when serotonin syndrome occurred. The time to peak plasma concentrations is approximately 1—1.5 hours. Teenagers and children 6 years of age and older and weighing less than 40 kg—Dose is based on body weight and must be determined by your doctor. Mirtazapine: (Major) Based on the mechanism of action of mirtazapine and the potential for serotonin syndrome, caution is advised when mirtazapine is coadministered with other drugs that may affect these neurotransmitter systems, including the serotonin-receptor agonists ("triptans"). Although rizatriptan benzoate 5mg tablets and orally disintegrating tablets are available in the marketplace, MAXALT Tablets and MAXALT-MLT Orally Disintegrating Tablets areno longer marketed in the 5mg strength. If serotonin syndrome is suspected, serotonergic agents should be discontinued and appropriate medical treatment should be implemented. Ergot alkaloids: (Severe) Serotonin-receptor agonists (triptans) are contraindicated for use within 24 hours of treatment with ergot alkaloids (e.g., dihydroergotamine, methysergide) or ergot-type medications to avoid the potential for serious coronary ischemia. Additive effects may occur, and the risk of serotonin syndrome may be increased. Maximum: 1 dose in any 24-hour period Serotonin syndrome may occur within recommended dose ranges. -For patients with coronary artery disease (CAD) risk factors, a cardiovascular evaluation should be performed prior to initiating therapy; for patients who have satisfactorily completed a cardiovascular evaluation, consider administering first dose in a medically supervised setting and performing an ECG immediately following administration. Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) Dextromethorphan inhibits serotonin reuptake and therefore should be used cautiously with serotonin-receptor agonists as serotonin syndrome may result. The monoamine oxidase type A enzyme metabolizes serotonin. Safety and efficacy of more than 1 dose per 24 hours have not been established. Rizatriptan does not need to be taken with fluids. Lithium: (Major) There is an increased risk of serotonin syndrome during concurrent use of drugs with central serotonergic properties such as lithium and serotonin-receptor agonists. Serotonin syndrome may occur within recommended dose ranges. Brompheniramine; Hydrocodone; Pseudoephedrine: (Moderate) Serotonin syndrome can occur during concomitant use of opiate agonists with serotonergic drugs, such as serotonin-receptor agonists. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome. Sample preparation for determination of Rizatriptan benzoate from dosage form: Twenty formulation (Tablet I) were weighed and finely powdered. -Coronary artery vasospasm including Prinzmetal's angina Serotonin syndrome can be serious and consists of symptoms such as mental status changes, diaphoresis, tremor, myoclonus, hyperreflexia, and fever. Chlorpheniramine; Hydrocodone; Pseudoephedrine: (Moderate) Serotonin syndrome can occur during concomitant use of opiate agonists with serotonergic drugs, such as serotonin-receptor agonists. Chlorpheniramine; Hydrocodone: (Moderate) Serotonin syndrome can occur during concomitant use of opiate agonists with serotonergic drugs, such as serotonin-receptor agonists. -Peripheral vascular disease Intermittent hemodialysisSee dosage for patients with renal impairment. The product's dosage form is tablet and is administered via oral … Tricyclic antidepressants inhibit norepinephrine and serotonin uptake, but rarely cause serotonin syndrome when used alone. Additive effects may occur, and the risk of serotonin syndrome may be increased. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. Pediatrics: Although unlikely to occur during monotherapy with serotonin-receptor agonists (or "triptans"), serotonin syndrome may occur from combining these drugs with other medications that potentiate serotonin activity. Symptoms may occur hours to days after concomitant use, particularly after dose increases. Taking these drugs together may increase the risk for serotonin syndrome. Use: For the acute treatment of migraine with or without aura in patients 6 years or older. Register Now. It is not intended to be a substitute for the exercise of professional judgment. Benzhydrocodone; Acetaminophen: (Moderate) Careful monitoring, particularly during treatment initiation and dose adjustment, is recommended during coadministration of benzhydrocodone and serotonin-receptor agonists because of the potential risk of serotonin syndrome. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome. It is not known whether hemodialysis (or peritoneal dialysis) removes rizatriptan from plasma. Additive effects may occur, and the risk of serotonin syndrome may be increased. ELDERLY: Dose selection should be cautious, generally starting at the low end of the dosing range. Discontinue the SSRI and rizatriptan and initiate symptomatic treatment if serotonin syndrome occurs. Lisdexamfetamine: (Moderate) Serotonin syndrome may occur during coadministration of serotonergic drugs such as amphetamines and serotonin-receptor agonists. -Provided there has been a response to first dose, a second dose may be administered at least 2 hours later if migraine returns Rizatriptan benzoate dosage. This interaction could lead to serotonin syndrome. If rizatriptan is administered according to the maximum dosage regimen, no drug accumulation in the plasma occurs from day to day. Patients receiving serotonergic drugs in combination should be informed of the signs and symptoms of serotonin syndrome. Medically reviewed by Drugs.com. Patients receiving serotonergic drugs in combination should be informed of the signs and symptoms of serotonin syndrome. -Initial dose: 5 mg orally once Dextromethorphan; Guaifenesin; Pseudoephedrine: (Moderate) Dextromethorphan inhibits serotonin reuptake and therefore should be used cautiously with serotonin-receptor agonists as serotonin syndrome may result. The 10-mg dose may provide... 3 DOSAGE FORMS & STRENGTHS CONCOMITANT USE WITH PROPRANOLOL: Symptoms may occur hours to days after concomitant use, particularly after dose increases. Propranolol increases rizatriptan AUC by 70%; decrease rizatriptan dose if coadministered adjustment needed (see Dosage Modifications) Ergot-containing drugs may cause prolonged vasospastic reactions; because these effects may be additive if coadministered, use of ergotamine-containing medications and rizatriptan are contraindicated within 24 hr Illicit use of cocaine is of potential concern for interactions. The AUC of rizatriptan in patients with renal impairment (CrCl 10—60 ml/min/1.73 m2) was not significantly different from healthy volunteers. Some patients had used the combination previously without incident. Additive serotonergic effects, including serotonin syndrome, may also occur. While uncommon, serotonin syndrome can be serious and consists of symptoms such as mental status changes, diaphoresis, tremor, myoclonus, hyperreflexia, and fever Methamphetamine: (Moderate) Serotonin syndrome may occur during coadministration of serotonergic drugs such as methamphetamine and serotonin-receptor agonists. Sibutramine: (Major) Sibutramine is a serotonin reuptake inhibitor. Rizatriptan is used to treat migraine headaches. Symptoms may occur hours to days after concomitant use, particularly after dose increases. Symptoms may occur hours to days after concomitant use, particularly after dose increases. 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