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Rizatriptan should only be used where a clear diagnosis of migraine has been establishedRizatriptan should not be administered to patients with basilar or haemiplegic migraineAs with other 5-HT 1B1D agonistssensations of tightnesspainpressure and heaviness have been reported after treatment with rizatriptan in the precordiumthroatneck and jawThese events have not been associated with arrhythmias or definite ischaemic electrocardiogramECGchanges in clinical trialsone patient experienced chest pain with possible ischaemic ECG changesBecause drugs in this class may cause coronary artery vasospasmpatients who experience signs or symptoms suggestive of angina following dosing should be evaluated for the presence of coronary artery diseaseCADor a predisposition to Prinzmetal’s variant angina before receiving additional doses of medicationand should be monitored by ECG if dosing is resumed and similar symptoms recurSimilarlypatients who experience other symptoms or signs suggestive of decreased arterial flowsuch as ischaemic bowel syndrome or Raynaud’s syndrome following the use of any 5-HT 1 agonist are candidates forfurther evaluation.
Ergot-containing drugs have been reported to cause prolonged vasospastic reactionsBecause there is a theoretical basis that these effects may be additiveuse of ergotamine-containing or ergot-type medicationslike dihydroergotamine or methysergideand rizatriptan within 24 hours is contraindicatedDue to an additive effectthe concomitant use of rizatriptan and ergotamine/ergot derivativesincluding methysergideincreases the risk of coronary artery vasoconstriction and hypertensive effectsThis combination is contraindicated.
Chemical propertiesrizatriptan may bind to melanin and accumulate in melanin-rich tissuee.geyesover timeThis raises the possibility that rizatriptan could cause toxicity in these tissues after extended useThere werehoweverno adverse ophthalmologic changes related to treatment with rizatriptan in the 1-year dog toxicity studyAlthough no systematic monitoring of ophthalmologic function was undertaken in clinical trials and no specific recommendations for ophthalmologic monitoring are offeredprescribers should be aware of the possibility of long-term ophthalmologic effects.
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