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INTRODUCTION

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rizatriptan (riz-a-trip-tan)

Maxalt, Maxalt-MLT

Classification

Therapeutic: vascular headache suppressants

Pharmacologic: 5-HT1 agonists

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Indications
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Acute treatment of migraine headache.

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Action
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Acts as an agonist at specific 5-HT1 receptor sites in intracranial blood vessels and sensory trigeminal nerves. Therapeutic Effects: Cranial vessel vasoconstriction with associated decrease in release of neuropeptides and resultant decrease in migraine headache.

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Adverse Reactions/Side Effects
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CNS: dizziness, drowsiness, weakness. CV: CORONARY ARTERY VASOSPASM, MI, VENTRICULAR FIBRILLATION, VENTRICULAR TACHYCARDIA, chest pain, myocardial ischemia. GI: dry mouth, nausea. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANGIOEDEMA, toxic epidermal necrolysis, pain.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Continually monitor for signs of coronary artery vasospasm and MI, including sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, and nausea. Seek immediate medical assistance if patient develops these signs.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, dizziness, fainting, and fatigue/weakness.

  • Monitor signs of allergic reactions and angioedema, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria, swelling in the face). Be especially alert for severe skin reactions that might indicate toxic epidermal necrosis. Notify physician immediately if these reactions occur.

  • Assess the frequency and severity of headaches, and document whether drug therapy is successful in decreasing the severity of migraine headache attacks.

  • Assess any muscle pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

  • Watch for dizziness and drowsiness that affects gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

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Interventions
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  • Because of the risk of MI and arrhythmias, use extreme caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, respiration, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

  • Implement appropriate interventions (manual techniques, physical agents, therapeutic exercise) to manage headache pain and reduce the need for drug therapy. Help patient also explore other nonpharmacologic methods to reduce chronic headache pain (relaxation techniques, imagery, and so forth).

  • If a headache occurs and drug treatment is needed during a rehabilitation session, allow patient to recover in a quiet, darkened room to allow the drug to achieve maximal effects.

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Patient/Client-Related Instruction
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  • Advise patient and family or caregiver about the signs of MI (see above under Examination and Evaluation), and to seek ...

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