Overview of Maxalt for Migraines

Understand Whether This Triptan Is Right For You

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Maxalt (rizatriptan) is a prescription medication used to alleviate migraine episodes. It is one of only a few medications in its category that is approved for adults as well as for children as young as age 6.

Maxalt was approved in 1998 and is one of seven triptans, which are a category of medications that work similarly to each other and are approved specifically for treatment of acute migraine episodes.

Indications

Maxalt is like other triptans in many ways, but it has some distinguishing characteristics.

Maxalt and other triptans are typically used to alleviate moderate to severe migraine attacks and may also be used for the treatment of milder migraine attacks that do not respond to over-the-counter analgesics like Advil (ibuprofen), Tylenol (acetaminophen), or Excedrin (acetaminophen/aspirin/caffeine).

Maxalt and other triptans may be beneficial for you if you experience menstrual migraines, if you are young, and if you do not have any cardiovascular risk factors.

Using Maxalt During a Migraine

Maxalt works faster than most triptans, taking effect within two hours, so it is one of the preferred options to take after your migraine symptoms have already started.

Because of its relatively fast onset of action, Maxalt may be the triptan of choice for you if you do not typically experience prodromal symptoms before your migraines begin.

How It Works

Maxalt and other triptans are 5-HT (serotonin) receptor agonists, which means that they augment the effect of serotonin, a neurotransmitter. This neurotransmitter is involved in regulating mood and pain. Triptans also induce vasoconstriction (narrowing of the blood vessels) in the brain.

Researchers are not sure whether the effects of triptans are related to the vasoconstriction, to serotonin-mediated pain or mood receptor activation, or to another action altogether. It is likely that a combination of these effects is at play.

Dosing and Formulation

Maxalt is available in a tablet form, which can be swallowed, or as an orally (by mouth) disintegrating tablet, which dissolves on your tongue. The orally disintegrating tablet may be appealing if you have difficulty swallowing pills. 

The tablet and the disintegrating forms are both available at 5 mg and 10 mg doses.

The recommended dose of Maxalt is:

Adults: You can take a 5 mg or 10 mg dose and you can repeat the dose two hours later. It is not safe to take more than 30 mg of Maxalt in a 24-hour period.

Children age 6 to 17 years: Children who weigh less than 88 pounds (40 kg) can take a 5 mg dose. Children who weigh more than 88 pounds can take a 10 mg dose.

Even though it is fast acting, it is best to take Maxalt at the onset of a migraine so that you can avert the maximal pain and other symptoms of your migraine.

Side Effects, Risks, and Contraindications

Maxalt has the same side effect profile as other triptans, and, while it is typically considered safe and effective, is not safe if you are pregnant or have certain health conditions.

Side Effects

It's important to speak with your doctor if you experience serious side effects within 48 hours of taking Maxalt.

Get urgent meical atention if you experience any of the following serious side effects:

  • Dry mouth (a symptom of serotonin syndrome, see below)
  • Heaviness, tightness, or pressure in chest, neck, and/or jaw
  • Faster or pounding heartbeat
  • Sensations of burning on the skin and numbness or tingling, especially of the face
  • Dizziness
  • A severe headache

Common, but less concerning side effects include:

  • Nausea
  • Flushing
  • Fatigue
  • Drowsiness
  • Mild tingling of your hands or fingers

If you experience any of the less concerning side effects, you should talk to your doctor or pharmacist for advice.

Overuse

Overuse of Maxalt can cause serious complications, including vascular ischemia, which is diminished blood supply. Severe and prolonged vasoconstriction can cause life-threatening ischemia anywhere in the body, inducing a stroke, heart attack, or damage of the internal organs.

Maxalt, like other triptans, can also trigger medication withdrawal headaches, also called medication overuse headaches, or medication rebound headaches. You can experience this type of headache if you take medication for a prolonged period of time and then suddenly stop. It is believed that discontinuation of the vasoconstrictive effect of triptans can induce medication withdrawal headaches, which are quite difficult to treat.

Contraindications

Your doctor will ask you questions about your medical history before prescribing Maxalt for your migraines because it is not safe for everyone.

You should not use Maxalt if you have any of the following health conditions:

  • Coronary artery disease, including a history of a heart attack
  • Hypertension
  • Vascular disease
  • A history of stroke or risk of stroke
  • Basilar or hemiplegic migraines
  • Kidney or liver impairment

Pregnancy and Breastfeeding

If you are taking Maxalt and are pregnant or planning on becoming pregnant, it's important to talk with your doctor. Maxalt is a pregnancy category C. This means that it's not known whether it will harm an unborn baby and is therefore not routinely used during pregnancy.

There is limited scientific evidence about the safety of triptans while breastfeeding, so you need to talk with your doctor if you are breastfeeding and considering taking Maxalt.

Medication Interactions

Since Maxalt and other triptans can interact with some medications, it's important that you provide your doctor with a complete list of all prescription medications, as well as over-the-counter supplements and vitamins. 

Maxalt should not be taken with selective serotonin reuptake inhibitors (SSRIs) or monoamine oxidase inhibitors (MAOIs), which are antidepressants that, like Maxalt, augment the action of serotonin. These combinations can cause can cause a rare but serious condition called serotonin syndrome, which manifests with anxiety, fevers, jerking movements, tremors, and muscle rigidity.

You also should not use Maxalt within the same 24 hour period as another triptan, ergotamines, or dihydroergotamine. This combination can induce severe vasoconstriction and may cause a stroke, heart attack, or life-threatening ischemia of the gastrointestinal system or kidneys.

A Word From Verywell

Maxalt is generally well-tolerated and effective for treatment of acute migraines. It advised that you limit Maxalt use to less than twice a week to prevent the onset of a medication overuse headache. If you find yourself having more frequent headaches, then you should talk to your doctor about avoiding migraine triggers and possibly taking prophylactic migraine medications.

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