Serotonin syndrome has been reported during concurrent use of serotonin-receptor agonists and serotonin norepinephrine reuptake inhibitors. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. Tranylcypromine: (Severe) Due to the risk of serotonin syndrome and significantly increased rizatriptan exposure, use is contraindicated with tranylcypromine. Methylene blue is a thiazine dye that is also a potent, reversible inhibitor of the enzyme responsible for the catabolism of serotonin in the brain (MAO-A) and serotonin-receptor agonists increase central serotonin effects. Symptoms may occur hours to days after concomitant use, particularly after dose increases. At high doses, amphetamines can increase serotonin release, as well as act as serotonin agonists. Some cases have involved hospitalization. Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine: (Moderate) Serotonin syndrome can occur during concomitant use of opiate agonists with serotonergic drugs, such as serotonin-receptor agonists. 2.1 Dosing Information in Adults The recommended starting dose of rizatriptan benzoate is either 5mgor 10mg for the acute Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome particularly during treatment initiation and dose increases. Amphetamine; Dextroamphetamine Salts: (Moderate) Serotonin syndrome may occur during coadministration of serotonergic drugs such as amphetamines and serotonin-receptor agonists. We comply with the HONcode standard for trustworthy health information -. Additive serotonergic effects, including serotonin syndrome, may also occur. If combination treatment with buprenorphine and a triptan is required, patients should be carefully observed, particularly during treatment initiation and during dose adjustments of the serotonergic drug; discontinue buprenorphine if serotonin syndrome is suspected. Serotonin syndrome may occur within recommended dose ranges. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome. Diphenhydramine; Hydrocodone; Phenylephrine: (Moderate) Serotonin syndrome can occur during concomitant use of opiate agonists with serotonergic drugs, such as serotonin-receptor agonists. Rizatriptan should be used with caution in geriatric patients and dose selection should be cautious, starting at the low end of the dosage range. We do not record any personal information entered above. maxalt. If serotonin-syndrome is suspected, offending agents should be discontinued. Administration advice: Brompheniramine; Hydrocodone; Pseudoephedrine: (Moderate) Serotonin syndrome can occur during concomitant use of opiate agonists with serotonergic drugs, such as serotonin-receptor agonists. Ergot alkaloids have been reported to cause prolonged vasospastic reactions which may be additive with the effects of triptans. Rizatriptan should be used cautiously in patients with hepatic disease experiencing moderate hepatic insufficiency due to an increase in plasma concentrations of approximately 30%. CONCOMITANT USE WITH PROPRANOLOL: Patients receiving serotonergic drugs in combination should be informed of the signs and symptoms of serotonin syndrome. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome particularly during treatment initiation and dose increases. It has very weak activity at other 5-HT receptors, but has no activity at alpha, beta, dopaminergic, histaminergic, muscarinic, or benzodiazepine receptors. Use Maxalt (Rizatriptan) exactly as directed on the label, or as prescribed by your doctor. -Ischemic bowel disease Additive effects may occur, and the risk of serotonin syndrome may be increased. Rizatriptan should be given cautiously to patients with peripheral vascular disease including Raynaud's phenomenon and ischemic bowel disease (colitis). Doxepin: (Moderate) Tricyclic antidepressants (TCAs) should be used cautiously with drugs that also augment serotonin, like the serotonin-receptor agonists ("triptans") used for the treatment of migraine. Although rizatriptan has little effect on other 5-HT receptors, activation of coronary 5-HT 1B receptors could result in clinically significant cardiac events in patients with cardiac disease or risk factors for cardiac disease. Serotonin syndrome may occur within recommended dose ranges. Selegiline: (Severe) Because of the potential risk and severity of serotonin syndrome, use of rizatriptan with or within 2 weeks of discontinuing transdermal selegiline, orally disintegrating selegiline tablets, and high doses of oral selegiline capsules and tablets is contraindicated. -For patients with coronary artery disease (CAD) risk factors, a cardiovascular evaluation should be performed prior to initiating therapy; for patients who have satisfactorily completed a cardiovascular evaluation, consider administering first dose in a medically supervised setting and performing an ECG immediately following administration. Serotonin syndrome, in its most severe form, can resemble neuroleptic malignant syndrome. Discontinue serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. Aspirin, ASA; Butalbital; Caffeine; Codeine: (Moderate) Serotonin syndrome can occur during concomitant use of opiate agonists with serotonergic drugs, such as serotonin-receptor agonists. Serotonin syndrome can be serious and consists of symptoms such as mental status changes, diaphoresis, tremor, myoclonus, hyperreflexia, and fever. Perphenazine; Amitriptyline: (Moderate) Tricyclic antidepressants (TCAs) should be used cautiously with drugs that also augment serotonin, like the serotonin-receptor agonists ("triptans") used for the treatment of migraine. arrhythmia exacerbation / Early / 0.1-1.0bradycardia / Rapid / 0.1-1.0akinesia / Delayed / 0-0.1muscle paralysis / Delayed / 0-0.1seizures / Delayed / Incidence not knownserotonin syndrome / Delayed / Incidence not knowncoronary vasospasm / Early / Incidence not knownmyocardial infarction / Delayed / Incidence not knownbowel ischemia / Delayed / Incidence not knownangioedema / Rapid / Incidence not knowntoxic epidermal necrolysis / Delayed / Incidence not knownintracranial bleeding / Delayed / Incidence not knownstroke / Early / Incidence not knownincreased intracranial pressure / Early / Incidence not known, chest pain (unspecified) / Early / 0-3.0chest pressure syndrome / Rapid / 0-3.0ataxia / Delayed / 0.1-1.0dysarthria / Delayed / 0.1-1.0hyperesthesia / Delayed / 0.1-1.0sinus tachycardia / Rapid / 0.1-1.0hypertension / Early / 0.1-1.0memory impairment / Delayed / 0.1-1.0confusion / Early / 0.1-1.0depression / Delayed / 0.1-1.0constipation / Delayed / 0.1-1.0edema / Delayed / 0.1-1.0dysphagia / Delayed / 0.1-1.0myasthenia / Delayed / 0.1-1.0blurred vision / Early / 0.1-1.0dehydration / Delayed / 0.1-1.0heat intolerance / Early / 0.1-1.0angina / Early / 0-0.1gastritis / Delayed / 0-0.1dysuria / Early / 0-0.1tachypnea / Early / 0-0.1erythema / Early / 0-0.1ocular inflammation / Early / 0-0.1hyperacusis / Delayed / 0-0.1photophobia / Early / 0-0.1photopsia / Delayed / 0-0.1palpitations / Early / 1.0euphoria / Early / 1.0hot flashes / Early / 1.0dyspnea / Early / 1.0withdrawal / Early / Incidence not knownhyperthermia / Delayed / Incidence not knownperipheral vasoconstriction / Rapid / Incidence not knownwheezing / Rapid / Incidence not known, dizziness / Early / 4.0-9.0drowsiness / Early / 4.0-8.0fatigue / Early / 4.0-7.0asthenia / Delayed / 4.0-7.0nausea / Early / 4.0-6.0paresthesias / Delayed / 3.0-4.0xerostomia / Early / 3.0-3.0headache / Early / 0-2.0insomnia / Early / 0.1-1.0vertigo / Early / 0.1-1.0agitation / Early / 0.1-1.0irritability / Delayed / 0.1-1.0anxiety / Delayed / 0.1-1.0flatulence / Early / 0.1-1.0gastroesophageal reflux / Delayed / 0.1-1.0dyspepsia / Early / 0.1-1.0musculoskeletal pain / Early / 0.1-1.0arthralgia / Delayed / 0.1-1.0myalgia / Early / 0.1-1.0muscle cramps / Delayed / 0.1-1.0menstrual irregularity / Delayed / 0.1-1.0polyuria / Early / 0.1-1.0increased urinary frequency / Early / 0.1-1.0nasal congestion / Early / 0.1-1.0nasal irritation / Early / 0.1-1.0throat irritation / Early / 0.1-1.0infection / Delayed / 0.1-1.0nasal dryness / Early / 0.1-1.0epistaxis / Delayed / 0.1-1.0yawning / Early / 0.1-1.0pharyngitis / Delayed / 0.1-1.0urticaria / Rapid / 0.1-1.0hyperhidrosis / Delayed / 0.1-1.0pruritus / Rapid / 0.1-1.0rash / Early / 0.1-1.0xerophthalmia / Early / 0.1-1.0ocular pain / Early / 0.1-1.0otalgia / Early / 0.1-1.0lacrimation / Early / 0.1-1.0ocular irritation / Rapid / 0.1-1.0tinnitus / Delayed / 0.1-1.0polydipsia / Early / 0.1-1.0chills / Rapid / 0.1-1.0hyporeflexia / Delayed / 0-0.1dysesthesia / Delayed / 0-0.1hyperkinesis / Delayed / 0-0.1eructation / Early / 0-0.1anorexia / Delayed / 0-0.1appetite stimulation / Delayed / 0-0.1hoarseness / Early / 0-0.1cough / Delayed / 0-0.1sneezing / Early / 0-0.1hiccups / Early / 0-0.1rhinorrhea / Early / 0-0.1acne vulgaris / Delayed / 0-0.1photosensitivity / Delayed / 0-0.1parosmia / Delayed / 0-0.1ocular pruritus / Rapid / 0-0.1syncope / Early / 0-0.1fever / Early / 0-0.1tremor / Early / 1.0hypoesthesia / Delayed / 1.0diarrhea / Early / 1.0vomiting / Early / 1.0dysgeusia / Early / Incidence not known. It is not intended to be a substitute for the exercise of professional judgment. MAXALT® and MAXALT RPD® (rizatriptan benzoate) Page 1 of 38. The recommended dose of Rizatriptan Benzoate is 5 mg in patients weighing less than 40 kg, and 10 mg in patients weighing 40 kg or more. Separate multiple email address with a comma. Non-selective traditional MAO inhibitors increase the plasma concentrations of these drugs and some of their active metabolites, thus increasing levels of serotonin. Symptoms may occur hours to days after concomitant use, particularly after dose increases. At high doses, amphetamines can increase serotonin release, as well as act as serotonin agonists. If concomitant treatment of tramadol and a serotonin-receptor agonist is clinically warranted, careful observation of the patient is advised, especially during the initial time both drugs are used together and during a dose increase of either tramadol or the serotonin-receptor agonist. Lithium: (Major) There is an increased risk of serotonin syndrome during concurrent use of drugs with central serotonergic properties such as lithium and serotonin-receptor agonists. Use: For the acute treatment of migraine with or without aura. Serotonin syndrome may occur within recommended dose ranges. Patients receiving serotonergic drugs in combination should be informed of the signs and symptoms of serotonin syndrome. Serotonin syndrome, in its most severe form, can resemble neuroleptic malignant syndrome. -Ischemic coronary artery disease (angina pectoris, history of myocardial infarction, or documented silent ischemia), or other significant underlying cardiovascular disease Hydrocodone; Phenylephrine: (Moderate) Serotonin syndrome can occur during concomitant use of opiate agonists with serotonergic drugs, such as serotonin-receptor agonists. Chlorpheniramine; Codeine: (Moderate) Serotonin syndrome can occur during concomitant use of opiate agonists with serotonergic drugs, such as serotonin-receptor agonists. Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Dextromethorphan inhibits serotonin reuptake and therefore should be used cautiously with serotonin-receptor agonists as serotonin syndrome may result. Serotonin syndrome can be serious and consists of symptoms such as mental status changes, diaphoresis, tremor, myoclonus, hyperreflexia, and fever. Nortriptyline: (Moderate) Tricyclic antidepressants (TCAs) should be used cautiously with drugs that also augment serotonin, like the serotonin-receptor agonists ("triptans") used for the treatment of migraine. Rizatriptan may cause a serious condition called serotonin syndrome when taken with some medicines. 2.1 Dosing Information in Adults - The recommended starting dose of rizatriptan benzoate tablets is either 5 mg or 10 mg for the acute treatment of migraines in adults. Multiple pharmacological actions have been derived that appear important for antimigraine effects.. 'Triptans' stimulate presynaptic 5-HT1D receptors, an action that inhibits both dural vasodilation and inflammation. Discontinue all serotonergic agents if serotonin syndrome occurs and implement appropriate medical management. -Hemiplegic or basilar migraine Maxalt-MLT/Rizatriptan/Rizatriptan Benzoate Oral Tab Orally Dis: 5mg, 10mg DOSAGE & INDICATIONS For the treatment of acute migraine attacks with or without aura. How to use Rizatriptan Benzoate? -Remove ODT from foil pouch at time of use Carbinoxamine; Dextromethorphan; Pseudoephedrine: (Moderate) Dextromethorphan inhibits serotonin reuptake and therefore should be used cautiously with serotonin-receptor agonists as serotonin syndrome may result. Children younger than 6 … Codeine; Guaifenesin: (Moderate) Serotonin syndrome can occur during concomitant use of opiate agonists with serotonergic drugs, such as serotonin-receptor agonists. Acetaminophen; Tramadol: (Moderate) Caution is advised when tramadol is coadministered with serotonin-receptor agonists because of the potential for serotonin syndrome. Methylene blue is a thiazine dye that is also a potent, reversible inhibitor of the enzyme responsible for the catabolism of serotonin in the brain (MAO-A) and serotonin-receptor agonists increase central serotonin effects. Serotonin syndrome may occur within recommended dose ranges. Discontinue the SSRI and rizatriptan and initiate symptomatic treatment if serotonin syndrome occurs. 5 mg PO as a single dose. -Patients should be aware of the risk of serious cardiovascular side effects and the importance of seeking medical advice promptly if they occur. © document.write(new Date().getFullYear()) PDR, LLC. Consult WARNINGS section for additional precautions. Rizatriptan should be used with extreme caution in patients with cerebrovascular disease, including intracranial bleeding, stroke or transient ischemic attacks, due to the vasospastic effects of 5-HT agonists. Some patients had used the combination previously without incident when serotonin syndrome occurred. Patients receiving concomitant administration of other antimigraine agents (e.g., beta-blockers including propranolol) with rizatriptan had similar adverse reaction rates as compared to those who did not receive these medications concomitantly. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome. There is no accumulation of rizatriptan with repeated dosing. -Initial dose: 10 mg orally once Rizatriptan benzoate shows maximum . Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. The efficacy and safety of treatment with more than one dose of Rizatriptan Benzoate within 24 hours in pediatric patients 6 to 17 years of age have not been established. You should confirm the information on the PDR.net site through independent sources and seek other professional guidance in all treatment and diagnosis decisions. Discontinue benzhydrocodone if serotonin syndrome is suspected. Symptoms may occur hours to days after concomitant use, particularly after dose increases. Rizatriptan and other 5-HT agonists may cause coronary vasospasm, and therefore are contraindicated in patients with known or suspected coronary artery disease (CAD), angina pectoris, vasospastic angina such as Prinzmetal's variant angina, arteriosclerosis, silent myocardial ischemia, acute myocardial infarction, history of myocardial infarction, or other significant cardiac disease. -The safety of treating an average of 4 or more migraine attacks in a 30-day period has not been established; the safety and effectiveness of more than 1 dose within 24 hours has not been established. MAXALT Tablets and MAXALT-MLT Orally Disintegrating Tablets are available for oral administration in strengths of 5 and 10 mg (corresponding to 7.265 mg or 14.53 mg of the benzoate salt, respectively). The dosage is based on your medical condition, response to treatment, age, and other medications you may be taking. Published interaction reports between intravenously administered methylene blue and serotonergic psychiatric agents have documented symptoms including lethargy, confusion, delirium, agitation, aggression, obtundation, myoclonus, expressive aphasia, hypertonia, pyrexia, elevated blood pressure, seizures, and/or coma. Serotonin syndrome can be serious and consists of symptoms such as mental status changes, diaphoresis, tremor, myoclonus, hyperreflexia, and fever. Symptoms may occur hours to days after concomitant use, particularly after dose increases. Hi, I'm a 35 year old woman and I've been suffering from vertigo and dizziness for about 8 months now with tinnitus and hearing loss in my left ear. The monoamine oxidase type A enzyme metabolizes serotonin. Serotonin syndrome has been reported during concurrent use of serotonin-receptor agonists and SSRIs. Symptoms may occur hours to days after concomitant use, particularly after dose increases. CrCl >= 10 ml/min: no dosage adjustment needed.CrCl < 10 ml/min: use rizatriptan with caution in dialysis patients as decreased clearance results in increased AUC. Additionally, vascular 5-HT1B receptor agonism results in vasoconstriction of painfully dilated intracranial extracerebral vessels.. Discontinue serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. Compared to a general population group, the odds ratio for congenital malformation was 1.03 (95% CI 0.55 to 1.93) among women who redeemed prescriptions for rizatriptan during the first trimester and 1.48 (95% CI 0.83 to 2.64) for those who redeemed prescriptions for rizatriptan before pregnancy. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome particularly after a dose increase or the addition of other serotonergic medications to an existing regimen. The safety of treating > 4 headaches in a 30-day period is not established. Select one or more newsletters to continue. Maxalt® (rizatriptan benzoate) is a selective 5-HT1B/1D receptor agonist indicated for the acute treatment of migraine, with or without aura, in adults and in children ages 6 to 17 who have a clear migraine diagnosis.It comes in 2 tablet forms, one that is swallowed and one that dissolves in the mouth. >= 6 years and >= 40 kg: 10 mg PO per 24 hour period. Preparation of the standard solution: Standard stock solution of Rizatriptan benzoate was prepared by transferring 10 mg of Rizatriptan benzoate into10ml volumetric flasks separately; it was dissolved and diluted to the mark with methanol to obtain standard solutions containing 1000µg/ml. Patients with symptomatic Wolff-Parkinson-White syndrome or cardiac arrhythmias associated with other cardiac accessory conduction pathway disorders should not receive rizatriptan because serious cardiac events have been reported within a few hours of receiving 5-HT1 agonists. The patient may take with fluids if desired. Some patients had used the combination previously without incident when serotonin syndrome occurred. Symptoms may occur hours to days after concomitant use, particularly after dose increases. Serotonin syndrome has been reported during concurrent use of serotonin-receptor agonists and serotonin norepinephrine reuptake inhibitors. Discontinue the SSRI and rizatriptan and initiate symptomatic treatment if serotonin syndrome occurs. Inform patients taking this combination of the possible increased risk and monitor for the emergence of serotonin syndrome particularly after a dose increase of the SSRI or the addition of other serotonergic medications to an existing SSRI regimen. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Use: For the acute treatment of migraine with or without aura in patients 6 years or older. Patients receiving serotonergic drugs in combination should be informed of the signs and symptoms of serotonin syndrome. Discontinue the serotonergic agents immediately if serotonin syndrome reactions occur and initiate supportive symptomatic treatment. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. Frovatriptan: (Severe) Rizatriptan is contraindicated for use within 24 hours of treatment with frovatriptan due to the risk for additive vasospastic reactions. Patients receiving serotonergic drugs in combination should be informed of the signs and symptoms of serotonin syndrome. In general, use with caution in geriatric patients due to a greater frequency of concomitant disease states, organ impairment, and drug therapies. This interaction is most likely due to first-pass metabolic interaction between rizatriptan and propranolol. May repeat every 2 hours with no more than 15 mg PO in any 24-hour period. Tricyclic antidepressants inhibit norepinephrine and serotonin uptake, but rarely cause serotonin syndrome when used alone. Serious CNS reactions, such as serotonin syndrome, have been reported during the concurrent use of linezolid, which is structurally similar to tedizolid, and psychiatric medications that enhance central serotonergic activity; therefore, caution is warranted with concomitant use of other agents with serotonergic activity. Serotonin syndrome can be serious and consists of symptoms such as mental status changes, diaphoresis, tremor, myoclonus, hyperreflexia, and fever. While stroke, cerebral hemorrhage, and related fatalities have been reported following administration of 5-HT1 agonists, these events may have been present prior to administration of the drug, and the drug was mistakenly given in response to the cerebrovascular symptoms. Additive serotonergic effects, including serotonin syndrome, may also occur. Of the 27 cases reviewed by the FDA, 2 were considered life-threatening and 13 required hospitalization. 2. Comments: It is thought that the interaction between SNRIs or SSRIs and serotonin-receptor agonists is the result of increased serotonergic activity by each of the drug classes. Published interaction reports between intravenously administered methylene blue and serotonergic psychiatric agents have documented symptoms including lethargy, confusion, delirium, agitation, aggression, obtundation, myoclonus, expressive aphasia, hypertonia, pyrexia, elevated blood pressure, seizures, and/or coma. The product's dosage form is tablet and is administered via oral … benzoate), or 10 mg of rizatriptan (corresponding to 14.53 mg of rizatriptan benzoate). Other side effects may include myocardial infarction, stroke, high blood pressure, serotonin syndrome, and anaphylaxis. 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