Maxalt (Rizatriptan Benzoate)

(rye za trip' tan)

Rizatriptan is used to treat the symptoms of migraine headaches (severe, throbbing headaches that sometimes are accompanied by nausea and sensitivity to sound and light). Rizatriptan is in a class of medications called selective serotonin receptor agonists. It works by narrowing blood vessels in the brain, stopping pain signals from being sent to the brain, and blocking the release of certain natural substances that cause pain, nausea, and other symptoms of migraine. Rizatriptan does not prevent migraine attacks or reduce the number of headaches you have.

Rizatriptan comes as a tablet and an orally disintegrating tablet to take by mouth. It is usually taken at the first sign of a migraine headache. If your symptoms improve after you take rizatriptan but return after 2 hours or longer, you may take a second tablet. However, if your symptoms do not improve after you take rizatriptan, do not take a second tablet before calling your doctor. Your doctor will tell you the maximum number of tablets you may take in a 24-hour period. Follow the directions on the package or prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take rizatriptan exactly as directed. Do not take more or less of it or take it more often than directed by the package label or prescribed by your doctor. You may take your first dose of rizatriptan in a doctor's office or other medical facility where you can be monitored for serious reactions. To take the orally disintegrating tablet, use dry hands to peel back the foil packaging.Immediately take out the tablet and place it on your tongue.The tablet will quickly dissolve and can be swallowed with saliva. No water is needed to swallow disintegrating tablets. Do not open the foil packaging or remove the orally disintegrating tablet until just before your are ready to take it. Call your doctor if your headaches do not get better or occur more frequently after taking rizatriptan. If you take rizatriptan more often or for longer than the recommended period of time, your headaches may get worse or may occur more frequently. You should not take rizatriptan or any other headache medication for more than 10 days per month. Call your doctor if you need to take rizatriptan to treat more than four headaches in a 1-month period. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Before taking rizatriptan
• tell your doctor and pharmacist if you are allergic to rizatriptan, any other medications, or any of the ingredients in rizatriptan tablets or orally disintegrating tablets. Ask your pharmacist for a list of the ingredients.
• do not take rizatriptan if you have taken any of the following medications in the past 24 hours: other selective serotonin receptor agonists such as almotriptan (Axert), eletriptan (Relpax), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex, in Treximet), or zolmitriptan (Zomig); or ergot-type medications such as bromocriptine (Parlodel), cabergoline, dihydroergotamine (D.H.E. 45, Migranal), ergoloid mesylates (Hydergine), ergonovine (Ergotrate), ergotamine (Cafergot, Ergomar), methylergonovine (Methergine), methysergide (Sansert), and pergolide (Permax).
• do not take rizatriptan if you are taking a monoamine oxidase A (MAO-A) inhibitor such as isocarboxazid (Marplan), phenelzine (Parnate), or tranylcypromine (Nardil) or if you have taken one of these medications in the past 2 weeks.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, or herbal products you are taking or plan to take. Be sure to mention any of the following: acetaminophen (Tylenol); antidepressants such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); propranolol (Inderal); selective serotonin reuptake inhibitors such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine, paroxetine (Paxil), and sertraline (Zoloft); and selective serotonin/norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Pristiq), duloxetine (Cymbalta), sibutramine (Meridia), and venlafaxine (Effexor). Your doctor may need to change the doses of your medications or monitor you more carefully for side effects.
• tell your doctor if you have or have ever had heart disease; a heart attack; angina (chest pain); irregular heartbeats; stroke or 'mini-stroke'; or circulation problems such as varicose veins, blood clots in the legs, Raynaud's disease (problems with blood flow to the fingers, toes, ears, and nose), or ischemic bowel disease (bloody diarrhea and stomach pain caused by decreased blood flow to the intestines). Your doctor may tell you not to take rizatriptan.
• tell your doctor if you smoke or are overweight; if you have or have ever had high blood pressure, diabetes, high cholesterol, or kidney or liver disease; if you have gone through menopause (change of life); or if any family members have or have ever had heart disease or stroke.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you plan to be sexually active while you are taking this medication, talk to your doctor about effective methods of birth control. If you become pregnant while taking rizatriptan, call your doctor.
• you should know that rizatriptan may make you drowsy. Do not drive a car or operate machinery until you know how this medication will affect you.
• talk to your doctor about your headache symptoms to make sure they are caused by migraine. Rizatriptan should not be used to treat hemiplegic or basilar migraine or headaches caused by other conditions (such as cluster headaches).
• if you have phenylketonuria (PKU, an inherited condition in which a special diet must be followed to prevent mental retardation), you should know that the orally disintegrating tablets contain aspartame that forms phenylalanine.

Unless your doctor tells you otherwise, continue your normal diet.

Rizatriptan may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• drowsiness
• dizziness
• tiredness
• upset stomach
• vomiting
• diarrhea
• muscle pain or cramps
• tremors
• flushing (feeling of warmth)
• dry mouth

Some side effects can be serious. If you experience any of these, call your doctor immediately or get emergency medical treatment:

• tightness, pain, pressure, or heaviness in the chest, throat, neck, or jaw
• rapid, pounding, or irregular heartbeat
• shortness of breath
• breaking out in a cold sweat
• lightheadedness
• slow or difficult speech
• weakness or numbness of an arm or leg
• sudden or severe stomach pain
• bloody diarrhea
• paleness or blue color of the fingers and toes
• pain, burning, or tingling in the hands or feet
• difficulty breathing or swallowing
• swelling of the face, throat, tongue, lips, lips, eyes, hands, feet, ankles, or lower legs
• rash
• itching
• changes in vision

Keep this medication in the container it came in, tightly closed, and out of reach of children. Do not remove tablets from the blister pack until just before use. Store the medication at room temperature and away from excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Keep all appointments with your doctor. Your blood pressure should be checked regularly. You should keep a headache diary by writing down when you have headaches and when you take rizatriptan. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.