Rizatriptan is a triptan-class antimigraine drug that constricts intracranial blood vessels by agonizing 5-HT1B/1D receptors. Before use, cardiovascular risk, serotonin syndrome, and drug interactions must be carefully assessed to reduce the risk of serious adverse events.

I. Cardiovascular Risk

1. Contraindicated and caution-required populations

Contraindicated in patients with ischemic heart disease, coronary artery spasm, or a history of myocardial infarction.

Contraindicated in patients with cerebrovascular disease, peripheral vascular disease, or uncontrolled hypertension.

Patients with cardiovascular risk factors (hypertension, diabetes, hyperlipidemia, smoking, obesity, postmenopausal women, men over 40) should have cardiac status assessed before first use.

2. Monitoring after medication

If chest pain, chest tightness, pressure, shortness of breath, or palpitations occur after taking the medication, stop it immediately and seek medical care.

If symptoms persist or worsen, complete examinations such as electrocardiogram and cardiac enzymes.

Long-term frequent users should have cardiovascular status assessed regularly.

3. Special situations

Contraindicated in patients with hemiplegic or basilar migraine.

Not for migraine prevention; avoid long-term use without an indication.

II. Serotonin Syndrome

1. Mechanism and high-risk factors

Rizatriptan can enhance serotonergic activity; the risk increases when used with SSRIs, SNRIs, MAO inhibitors, tricyclic antidepressants, tramadol, lithium, St. John's wort, and similar agents.

Contraindicated with MAO inhibitors; do not use this product within 2 weeks after stopping an MAO inhibitor.

2. Recognizing symptoms

Mental status changes: agitation, hallucinations, confusion.

Autonomic symptoms: fever, sweating, tachycardia, blood pressure fluctuations.

Neuromuscular abnormalities: tremor, myoclonus, hyperreflexia, ataxia.

Gastrointestinal symptoms: nausea, vomiting, diarrhea.

3. Management principles

If serotonin syndrome is suspected, stop the medication immediately and seek medical care.

Mild cases can be managed by stopping the medication and observing; severe cases require inpatient supportive treatment.

Patients taking the above medications should use this product under medical guidance and be closely monitored.

III. Drug Interactions

1. Propranolol

May increase the blood concentration of rizatriptan; the single dose should not exceed 5 mg, and the total dose within 24 hours should not exceed 10 mg.

2. MAO inhibitors

Concomitant use is prohibited; at least 2 weeks must pass after stopping before this product can be used.

3. Other serotonergic drugs

When used with SSRIs, SNRIs, tramadol, lithium, and similar agents, monitor for symptoms of serotonin syndrome.

4. Ergot drugs

Concomitant use with ergotamine, dihydroergotamine, and similar agents may worsen vasoconstriction; the two drugs must be separated by at least 6 hours.

5. Other triptans

Do not use with other triptan drugs on the same day.

6. Medication disclosure

At medical visits, proactively inform the doctor of all medications in use, including prescription drugs, over-the-counter drugs, and herbal medicines, and avoid adding medications on your own.