Rizatriptan (Maxalt): Uses, Dosage, Side Effects and Cost in Canada

Rizatriptan (Maxalt) is a prescription triptan for acute migraine attacks. Learn how and when to take it, the daily limit, its side effects and who should not use it.

pain reliefDoctor-reviewedPrescriptionAvailable in Canada
Illustration of a blister strip of tablets and a dissolving wafer for Rizatriptan (Maxalt)

Disclaimer: This article is for informational purposes only and does not constitute medical advice. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition.

Overview

Rizatriptan is a prescription medicine for treating migraine attacks, with or without an aura. In Canada the original brand is Maxalt, which comes as a tablet, and Maxalt RPD, a wafer that dissolves on the tongue. Generic rizatriptan is also sold.

It works best when taken as a migraine headache begins. It relieves the attack but does not prevent future ones, and it is not for ordinary tension headaches. It narrows blood vessels, so a prescriber checks your heart and blood pressure history and your other medicines first.

If migraines are disrupting your life, BC residents can speak with a BC-licensed doctor by phone through Avee Health about their symptoms and next steps. A prescription is not guaranteed.

In Canada, Maxalt (rizatriptan) is authorized for:

  • The acute treatment of migraine attacks, with or without aura, in adults

It is not for preventing migraines or for headaches that are not migraine. Ask your prescriber about use under 18.

Generic name

Rizatriptan

Drug class

Triptan (5-HT1 receptor agonist)

Category

pain relief

Availability

Prescription required

In Canada

Available

How Rizatriptan Works

Rizatriptan belongs to the triptan group. It activates serotonin 5-HT1B and 5-HT1D receptors, which narrows the swollen blood vessels around the brain during a migraine and reduces the release of substances that cause pain and inflammation.

It treats the migraine attack itself. It is not a general painkiller, and it does not prevent future attacks.

Dosage Instructions of Rizatriptan

Take rizatriptan exactly as your prescriber directs. It is used to treat a migraine attack, not to prevent one. Canadian product information gives these points:

  • Adults: a single 5 mg or 10 mg dose at the start of the migraine headache. The prescriber chooses the strength.
  • If the headache comes back, a second dose can be taken, but not sooner than 2 hours after the first.
  • Do not take more than 20 mg in any 24-hour period.
  • If the first dose does not help at all, do not take a second dose for the same attack. Talk to your doctor, because the diagnosis may need to be reconsidered before the next attack is treated.
  • People taking propranolol need the lower 5 mg dose and a lower daily limit, set by the prescriber.
  • Maxalt RPD wafers: leave the wafer in its package until you are ready to use it, then place it on the tongue, where it dissolves. No water is needed.

Storage Instructions

Store as directed on the package. Keep Maxalt RPD wafers in their package until just before use. Keep out of the reach and sight of children.

Side Effects of Rizatriptan

Common side effects in migraine studies include drowsiness, tiredness or weakness, dizziness, nausea and sensations of pain, tightness or pressure in the chest, neck, throat or jaw. Tingling, flushing and dry mouth can also occur. These effects are usually short-lived.

Get medical help right away if you have:

  • Severe chest pain or pressure that does not go away, pain spreading to the arm or jaw, shortness of breath, a racing or irregular heartbeat, which can be a heart problem
  • Sudden severe stomach pain or bloody diarrhea, or cold, blue or painful fingers or toes, which can be signs of reduced blood flow
  • Agitation, hallucinations, fever, sweating, shivering, muscle twitching or stiffness, or a fast heartbeat, which can be serotonin syndrome
  • Weakness on one side of the body, trouble speaking, a sudden severe headache, or vision changes, which can be a stroke
  • Swelling of the face, lips, tongue or throat, trouble breathing, or a severe rash, which can be an allergic reaction

Important Safety Information About Rizatriptan

  • Heart and blood vessels: do not use rizatriptan if you have a history, symptoms or signs of ischemic heart disease, stroke or poor circulation, or uncontrolled high blood pressure. It can raise blood pressure. Rare serious heart events, including heart attack, have been reported within hours of a dose.
  • Type of migraine: do not use it for hemiplegic, ophthalmoplegic or basilar migraine. Only use it when migraine has been properly diagnosed.
  • Drug limits: do not take it within 24 hours of another triptan or an ergot medicine, or with MAO inhibitors or within 2 weeks of stopping one.
  • Allergy: do not take it if you are allergic to rizatriptan or any ingredient.
  • Risk factors: tell your prescriber if you smoke, are overweight, have diabetes, high cholesterol, a family history of heart disease, or are a man over 40 or a woman after menopause. A heart check may be needed before the first dose.
  • Serotonin syndrome: this rare reaction can happen when triptans are taken with SSRI or SNRI antidepressants or other serotonin-raising medicines.
  • Wafers (Maxalt RPD): they contain phenylalanine, so tell your prescriber if you have phenylketonuria.
  • Frequent use: using migraine medicines on many days a month can lead to medication-overuse headache. If you need treatment often, ask your doctor about other options.
  • Drowsiness: see how it affects you before driving or using machinery.

Drug Interactions

Tell your prescriber and pharmacist about everything you take, including vitamins and natural products. Points to know:

  • MAO inhibitors (such as moclobemide, phenelzine and tranylcypromine): must not be taken together, or within 2 weeks of stopping one
  • Other triptans, and ergot medicines such as ergotamine, dihydroergotamine and methysergide: must not be taken within 24 hours of rizatriptan
  • Propranolol: raises rizatriptan levels. Only the 5 mg dose is used, with a lower daily limit
  • SSRI and SNRI antidepressants, and other medicines that raise serotonin: can increase the risk of serotonin syndrome, a rare but serious reaction. Tell your prescriber

Brands & DIN Number of Rizatriptan

Brand Names

  • Maxalt
  • Maxalt RPD

Key Takeaways

  • 1Rizatriptan (Maxalt) is a prescription triptan authorized in Canada for the acute treatment of migraine attacks. It does not prevent migraines.
  • 2Adults usually take a single 5 mg or 10 mg dose at the start of the headache. A second dose can be taken no sooner than 2 hours later.
  • 3Do not take more than 20 mg in any 24-hour period.
  • 4Common side effects are drowsiness, tiredness, dizziness and tightness or pressure in the chest, neck or throat.
  • 5It must not be used with ischemic heart disease, uncontrolled high blood pressure, or hemiplegic, ophthalmoplegic or basilar migraine.
  • 6Never combine it with MAO inhibitors, other triptans or ergot medicines within the time limits above.
  • 7Get urgent help for severe or lasting chest pain, trouble breathing, or an allergic reaction.

Frequently Asked Questions

Do I need a prescription for rizatriptan in Canada, and how do I get it in BC?
Yes. Rizatriptan is a prescription medicine in Canada. BC residents can speak with a BC-licensed doctor by phone through Avee Health about their symptoms. The doctor will confirm that your headaches fit migraine and ask about heart disease, high blood pressure and your other medicines before deciding whether a triptan is appropriate. A prescription is not guaranteed.
When should I take rizatriptan, and what if it does not work?
Take it once the migraine headache has started. It treats an attack that is already under way and does not prevent attacks. If the first dose gives no relief, do not repeat it for the same attack, and ask your doctor whether the diagnosis should be reviewed.
How many doses of rizatriptan can I take in a day?
If the headache returns, a second dose can be taken no sooner than 2 hours after the first. Do not take more than 20 mg in any 24-hour period. People taking propranolol have a lower limit set by their prescriber.
What is the difference between Maxalt and Maxalt RPD?
Maxalt is a regular tablet and Maxalt RPD is a wafer that dissolves on the tongue, so it can be taken without water. Wafers contain phenylalanine, which matters for people with phenylketonuria.
Is rizatriptan safe if I have heart disease or high blood pressure?
Rizatriptan narrows blood vessels and can raise blood pressure, so it must not be used by people with a history, symptoms or signs of ischemic heart disease, stroke or poor circulation, or with uncontrolled high blood pressure. Rare serious heart events, including heart attack, have been reported within hours of a dose.
Can I take rizatriptan with antidepressants or propranolol?
Do not take it with MAO inhibitors, or within 2 weeks of stopping one, or within 24 hours of another triptan or an ergot medicine. Propranolol raises rizatriptan levels, so only the lower dose is used. Antidepressants such as SSRIs and SNRIs can raise the risk of serotonin syndrome, so tell your prescriber about every medicine you take.
Why does rizatriptan cause chest or neck tightness?
Triptans can cause tightness or pressure in the chest, neck, throat or jaw, along with tingling, flushing, dizziness, drowsiness or tiredness. These usually pass. Get urgent medical help for chest pain that is severe or does not go away, shortness of breath, or signs of an allergic reaction.
How much does rizatriptan cost in Canada?
The price depends on the strength, the form, the number of tablets or wafers and the pharmacy, and generic rizatriptan is also sold. Coverage varies by plan, so check with your pharmacy or insurer.
Written By
Avee Editorial

Avee Editorial

Avee Editorial Team