100 Migraine Drugs, A to Z: rizatriptan

Rizatriptan (Maxalt, Maxalt MLT) is one of the seven triptans approved in the US. Along with zolmitriptan, it is one of the two triptans available in an orally disintegrating form – it melts in your mouth and does not require water to take it. This is important for those migraine sufferers who are so nauseous that they cannot drink even a small amount of fluid without throwing it up. It also means that you can take it when water is not immediately available. This is important since the earlier you take an abortive drug the better the results.

Another unique feature of rizatriptan is that the FDA-approved dose is up to three 10-mg tablets a day (it is also available in 5-mg tablets), while all other triptans have a limit of 2 a day. This does not mean that there is any significant difference in how different short-acting triptans are processed in your body or that taking sumatriptan three times in one day is dangerous. Unfortunately, many doctors blindly follow the rules and sternly warn patients not to exceed the FDA-recommended dose. The 5 most effective triptans (this excludes naratriptan and especially frovatriptan) have a half-life of 2-3 hours, which means that half of a single dose is gone from your body in 2-3 hours and after 6-8 hours, almost all of it is washed out. Naratriptan has a half-life of 6 hours and frovatriptan, 26 hours. Even if you were to take narartriptan three times a day it would not endanger your life, unless you have coronary artery disease or another contraindication to triptans in general.

These contraindications include uncontrolled hypertension, history of a stroke or a heart attack, and multiple risk factors for coronary artery disease. You may still be able to take triptans if you have some risk factors, but you would need to have your coronary arteries checked with coronary calcium scoring, stress test, or an angiogram.