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The development of a potentially life-threatening serotonin syndrome may occur with triptansincluding rizatriptan treatmentparticularly during combined use with SSRIs or SNRIsIf concomitant treatment with rizatriptan and an SSRIe.gfluoxetineparoxetinesertralinefluvoxaminecitalopramescitalopramor SNRIe.gvenlafaxineduloxetineis clinically warrantedcareful observation of the patient is advisedparticularly during treatment initiation and dose increases or with addition of another serotonergic medicationSerotonin syndrome symptoms may include mental status changese.gagitationhallucinationsand comaautonomic instabilitye.gtachycardialabile blood pressureand hyperthermianeuromuscular aberrationse.ghyperreflexiaincoordinationand/or gastrointestinal symptomse.gnauseavomitingand diarrhoea

As with other 5-HT1 agonistssensations of tightnesspainpressureand heaviness in the precordiumthroatneck and jaw commonly occur after treatment with rizatriptan and are usually noncardiac in originHoweverif a cardiac origin is suspectedpatients should be evaluatedPatients shown to have CAD and those with Prinzmetal’s variant angina should not receive 5-HT1 agonists.

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 for further evaluation.

Rizatriptan should be used with caution in dialysis patients due to a decrease in the clearance of rizatriptan.

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