Maxalt/Rizatriptan

Triptans are a well-established class of acute migraine medicines, each sharing the same fundamental mechanism but differing in formulation, speed of onset, duration of action, and interaction profile. Rizatriptan tablets, available as the branded product Maxalt and as generic rizatriptan, are a triptan Prescription Only Medicine used for the acute treatment of migraine with or without aura in adults.

An important interaction with propranolol, a commonly prescribed medicine for both migraine prevention and heart conditions, requires dose adjustment and must be checked before prescribing. A prescription can only be issued following a clinical consultation.

IMPORTANT — PROPRANOLOL INTERACTION: Patients taking propranolol for migraine prevention or any other indication must use a reduced dose of Rizatriptan (5 mg, not 10 mg). Propranolol significantly increases Rizatriptan blood levels. The maximum dose for patients on propranolol is 5 mg per attack, with a maximum of two 5 mg doses in any 24-hour period. Standard 10 mg tablets are not appropriate in this patient group. Prescribers must check for propranolol use before prescribing Rizatriptan 10 mg.

Rizatriptan tablets are an oral prescription medicine belonging to the triptan class of antimigraine medicines. The active ingredient is Rizatriptan benzoate. Maxalt is the originator brand manufactured by Organon; generic Rizatriptan tablets from other manufacturers are also widely available.

Rizatriptan is licensed in the UK for the acute treatment of migraine attacks, with or without aura, in adults. It is not for prevention of migraine. It should be taken once the headache phase of the attack has begun and is not effective during the aura phase.

Rizatriptan is a Prescription Only Medicine at both the 5 mg and 10 mg doses.

Rizatriptan is available in two formulations: standard tablets (Maxalt) and orally disintegrating wafer tablets (Maxalt Melt). The wafer formulation dissolves on the tongue without water, which can be useful during a migraine when nausea makes swallowing difficult. This page covers the standard tablet formulation only. Maxalt Melt is a separate product. The active ingredient and dose are the same in both formulations.

Rizatriptan relieves migraine through selective agonism of specific serotonin receptors involved in migraine pain mechanisms.

5-HT1B/1D Receptor Agonism

Rizatriptan is a selective agonist of 5-HT1B and 5-HT1D serotonin receptors. Activation of 5-HT1B receptors causes vasoconstriction of the dilated intracranial blood vessels that contribute to the throbbing pain of a migraine. Activation of 5-HT1D receptors on trigeminal nerve terminals reduces the release of vasoactive neuropeptides responsible for neurogenic inflammation and pain signal transmission along the trigeminal nerve pathway. These actions target two of the core mechanisms driving migraine pain.

Speed of Onset

Rizatriptan has a relatively rapid onset of action compared to some other oral triptans. After an oral tablet dose, peak blood levels are typically reached within one to one and a half hours. Many patients notice pain relief within 30 to 60 minutes, though individual response varies.

The orally disintegrating wafer formulation (Maxalt Melt) has a similar pharmacokinetic profile to the tablet despite dissolving on the tongue, as the active compound is absorbed through the gastrointestinal tract rather than sublingually.

Because Rizatriptan shares the same 5-HT1B/1D mechanism as all triptans, it is not effective for non-migraine headaches. It relieves migraine pain through the specific pathophysiology of migraine rather than through general pain management pathways.

Always take Rizatriptan exactly as your prescriber instructs. The information below summarises key points from the current UK SmPC. Read the Patient Information Leaflet supplied with your medicine before taking it.

• Take Rizatriptan as soon as possible once the headache phase of your migraine begins. It works most effectively when taken early in the attack. Do not take it during the aura phase; wait until the headache starts.
• Swallow the tablet whole with water.
• The standard dose is 10 mg. If you are taking propranolol, the dose must be reduced to 5 mg — see the propranolol interaction note and discuss with your prescriber.
• If the first dose does not relieve your migraine, do not take a second dose for the same attack. Rizatriptan is unlikely to provide relief once an initial dose in the same attack has failed.
• If your migraine improves after the first dose but then returns, a second dose may be taken for the recurrent headache. At least two hours must pass between doses.
• Do not exceed 20 mg (two 10 mg tablets) in any 24-hour period. Patients on propranolol must not exceed 10 mg (two 5 mg doses) in any 24-hour period.
• Do not take Rizatriptan on more than 10 days in any calendar month. Frequent use of acute headache medicines can cause medication overuse headache, a chronic daily headache condition that develops from overuse of the medicines intended to treat it.
• Rizatriptan tablets can be taken with or without food, though food may slightly delay the onset of action.
• If nausea makes swallowing tablets difficult, speak to your prescriber about whether the Maxalt Melt orally disintegrating wafer formulation would be more appropriate for you.

Rizatriptan 10 mg Tablets

The standard dose is 10 mg per migraine attack. This is the dose used by most adults who do not take propranolol. The maximum dose in any 24-hour period is 20 mg. Rizatriptan 10 mg tablets are a Prescription Only Medicine and require a valid prescription following a clinical consultation.

Rizatriptan 5 mg: Required Dose Reduction for Patients Taking Propranolol

For patients who take propranolol (whether for migraine prevention, hypertension, anxiety, or any other indication), the Rizatriptan dose must be reduced to 5 mg per attack, with a maximum of two 5 mg doses (10 mg total) in any 24-hour period.

Propranolol inhibits MAO-A, an enzyme involved in Rizatriptan metabolism, causing Rizatriptan blood levels to approximately double. This drug interaction is well documented in the SmPC and requires prescribers to check for propranolol use before issuing a Rizatriptan prescription.

Rizatriptan 5 mg tablets are available as a separate lower-dose product. Patients requiring the 5 mg dose must ensure their prescription specifies 5 mg. Do not halve a 10 mg tablet unless specifically instructed by your prescriber and pharmacist, as tablet-splitting may not provide an accurate dose.

Like all triptans, Rizatriptan can cause side effects. The information below is based on the current UK SmPC. Refer to the Patient Information Leaflet for the full list.

Common Side Effects (may affect up to 1 in 10 people)

• Sensations of warmth, tingling, heaviness, pressure, or tightness — triptan class effects. These may affect the chest, neck, throat, limbs, or face and are typically brief.
• Dizziness.
• Drowsiness or somnolence.
• Nausea.
• Fatigue or weakness.
• Dry mouth.

Important: Chest Symptoms

Chest tightness, pressure, or pain can occur after taking rizatriptan. In most cases these are related to the vasoconstriction effect of the medicine and are not cardiac in origin. However, Rizatriptan is contraindicated in patients with known or suspected cardiovascular disease. Any new or worsening chest symptoms should be assessed medically. If you experience severe chest pain or tightness, stop taking Rizatriptan and seek urgent medical attention.

Serious Side Effects: Seek Urgent Medical Attention

Go to your nearest accident and emergency department or call 999 immediately if you experience:

• Severe chest pain or tightness. Rizatriptan causes vasoconstriction and must not be used in patients with known cardiovascular disease.
• Signs of a stroke such as sudden weakness on one side of the body, sudden difficulty speaking, or sudden severe headache different from your usual migraine.
• Signs of serotonin syndrome: agitation, confusion, rapid heart rate, muscle twitching, high temperature, and loss of coordination. This is a rare but serious risk when Rizatriptan is combined with other serotonergic medicines.
• Signs of a severe allergic reaction such as sudden swelling of the face, lips, tongue, or throat, or difficulty breathing.

Report any suspected side effect to your prescriber, pharmacist, or via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk.

Rizatriptan Tablets May Be Suitable If You:

• Are an adult aged 18 or over with a confirmed diagnosis of migraine with or without aura.
• Have migraine attacks that have not been adequately controlled with standard analgesics such as paracetamol or ibuprofen.
• Do not have any of the cardiovascular or other contraindications listed below.
• Are already prescribed Rizatriptan and require a repeat prescription through an online prescribing service.

Rizatriptan Tablets Are Contraindicated If You:

• Have a history of myocardial infarction, ischaemic heart disease, coronary artery vasospasm (including Prinzmetal's angina), or any other significant cardiovascular disease.
• Have had a stroke or transient ischaemic attack (TIA).
• Have peripheral vascular disease.
• Have uncontrolled hypertension.
• Have hemiplegic, basilar, or ophthalmoplegic migraine.
• Are taking an ergotamine or ergot derivative (such as dihydroergotamine). Rizatriptan must not be taken within 24 hours of ergotamine preparations or vice versa.
• Are taking another triptan medicine. Do not take two different triptans within 24 hours.
• Are taking a monoamine oxidase inhibitor (MAOI) or have taken one within two weeks.
• Have severe liver impairment or severe kidney impairment.
• Have a known allergy or hypersensitivity to Rizatriptan or any excipient listed in the SmPC.

Tell your prescriber about all medicines you take. Key interactions for rizatriptan:

• Propranolol: a critically important interaction. Propranolol inhibits the enzyme MAO-A, causing Rizatriptan blood levels to approximately double. Patients taking propranolol must use Rizatriptan 5 mg (not 10 mg) with a maximum of 10 mg in 24 hours. This applies regardless of the indication for propranolol — whether it is being taken for migraine prevention, hypertension, anxiety, or a heart condition. Always inform your prescriber if you take propranolol.
• Other beta-blockers: the interaction is considered specific to propranolol among beta-blockers. Other beta-blockers such as atenolol or metoprolol do not share this interaction to the same extent per the current SmPC.
• MAOIs: contraindicated. Combined use increases Rizatriptan blood levels significantly.
• Ergotamine and ergot derivatives: contraindicated. Do not take within 24 hours of Rizatriptan in either direction.
• Other triptans: do not combine or take within 24 hours.
• SSRIs, SNRIs, and other serotonergic medicines: may increase the risk of serotonin syndrome. Monitor for symptoms if these medicines are taken together.

Your prescriber will review your complete medicines list, with particular attention to propranolol use, before any Rizatriptan prescription is issued.

Rizatriptan is a Prescription Only Medicine. The clinical consultation is the essential first step. A prescription will only be issued if a registered prescriber concludes, based on their individual assessment of your circumstances, that Rizatriptan is clinically appropriate for you.

During your online consultation with Pharmacy Planet, a registered prescriber will review the information you provide. This includes your migraine history, cardiovascular health, current medicines, blood pressure history, and any history of stroke or TIA. Critically, the prescriber will check whether you take propranolol, as this determines whether the 10 mg or 5 mg dose is appropriate. Patients on propranolol cannot be prescribed Rizatriptan 10 mg.

Not all consultations will result in a prescription. The prescriber may determine that Rizatriptan is not appropriate given your cardiovascular history or current medicines, recommend a different triptan with a more suitable interaction profile, or advise that a face-to-face consultation with your GP is needed. This process is designed to protect your safety.

If you are under the care of your GP for migraine management, please keep them informed of all medicines prescribed through online services. Coordinated care is particularly important when several medicines are being used for migraine prevention and treatment.

Store below 30°C. Store in the original packaging to protect from moisture. Keep out of the sight and reach of children. Do not use after the expiry date printed on the packaging. Do not dispose of medicines via household waste or wastewater. Return unused or out of date tablets to your pharmacist for safe disposal. Full storage instructions are provided in the Patient Information Leaflet supplied with your medicine.

Pharmacy Planet is a GPhC-registered online pharmacy providing access to prescription medicines through a clinically led consultation process. Our registered prescribers and pharmacists are committed to patient safety, clinical accuracy, and responsible prescribing. We follow GPhC standards, MHRA guidance, and ASA advertising regulations in all aspects of our service. For medicines with clinically important interactions such as Rizatriptan and propranolol, our prescribers are trained to check for all relevant medicines before any prescription is issued. Every prescription is reviewed and dispensed by qualified healthcare professionals.

If you have questions about rizatriptan, Maxalt, or acute migraine therapy, our pharmacy team is available to help. We are committed to transparent, patient centred care.

References

1. Electronic Medicines Compendium (eMC). Maxalt 10 mg tablets — Summary of Product Characteristics. https://www.medicines.org.uk/emc. Accessed May 2026.
2. National Institute for Health and Care Excellence (NICE). Headaches in over 12s: diagnosis and management. NICE guideline CG150. https://www.nice.org.uk/guidance/cg150. Accessed May 2026.
3. NHS. Rizatriptan. https://www.nhs.uk/medicines/rizatriptan. Accessed May 2026.
4. Joint Formulary Committee. British National Formulary (BNF). Rizatriptan. BMJ Group and Pharmaceutical Press. https://bnf.nice.org.uk. Accessed May 2026.
5. Medicines and Healthcare products Regulatory Agency (MHRA). Yellow Card — report a side effect. https://yellowcard.mhra.gov.uk. Accessed May 2026.

Triptan Tablets for Acute Migraine

The table below compares commonly prescribed triptan tablets available at Pharmacy Planet. All of the medicines below treat acute migraine attacks. Key differences lie in starting dose, the propranolol interaction (rizatriptan), the moclobemide and cimetidine interaction (zolmitriptan), and the sumatriptan 50 mg Pharmacy Medicine status.

Important: This comparison is for general information only and does not replace medical advice. A prescriber will decide which treatment is suitable for you following an online consultation.