How does it work?
Maxalt tablets and Maxalt melt tablets both contain the active ingredient rizatriptan, which is a type of medicine called a serotonin (or 5HT) agonist. This type of medicine is also commonly known as a 'triptan'. It is a painkiller specifically used to relieve migraine attacks.
Although the cause of migraine attacks is not fully understood, it is thought that widening of blood vessels in the brain causes the throbbing pain of migraine headaches. Rizatriptan relieves this pain by causing the blood vessels in the brain to narrow.
Rizatriptan works by stimulating receptors called serotonin (or 5HT) receptors that are found in the brain. A natural substance called serotonin normally acts on these receptors, causing blood vessels in the brain to narrow. Rizatriptan mimics this action of serotonin by directly stimulating the serotonin receptors in the brain. This narrows the blood vessels and so relieves the pain of migraine headaches.
The dose of rizatriptan should be taken as early as possible after the migraine headache has started, though it is also effective if taken at a later stage during the migraine attack. It should not be taken during the aura, or warning phase that can occur before a migraine headache, as the safety and effectiveness of the medicine have not been established during this period, and the medicine will not prevent the headache.
Maxalt melt tablets are designed to melt on the tongue in your saliva so they can be taken without the need for a drink of water. They may be particularly useful for people who feel sick or vomit during their migraine attack and are unable to drink, as well as for people who can't swallow conventional tablets.
What is it used for?
- Relieving migraine headaches.
- This medicine should not be used to prevent migraines.
- This medicine should only be used by people with a clear diagnosis of migraine from their doctor.
- This medicine should preferably be taken on an empty stomach, because the presence of food in the stomach can delay the effect of the medicine for approximately an hour.
- If the first dose of this medicine doesn't relieve your migraine headache then you should NOT take another dose for the same attack, as this has not been shown to be effective. (You can still take Maxalt for your next attack.) If the first dose does initially relieve your migraine, but the headache then comes back, you can take a second dose. However, if you need a second dose because your migraine has returned, you should NOT take it within two hours of your first dose. Do not take more than two doses in 24 hours.
- Do not exceed the recommended dose.
- Using any painkillers for headaches too often or for too long can actually make the headaches worse. If you find you need to use this medicine frequently you should consult your doctor for advice.
- This medicine can cause feelings of warmth, heaviness, pressure, tightness, tingling or pain in certain parts of the body, including the chest or throat. Although sometimes very strong, these feelings usually only last a few minutes. If they continue or are particularly severe (especially chest pain), you should not take any more tablets and consult your doctor immediately.
- This medicine may cause drowsiness. If affected do not drive or operate machinery.
Use with caution in
- Mild to moderately decreased kidney function.
- Mild to moderately decreased liver function.
- People with risk factors for coronary heart disease, such as smoking, high cholesterol levels, high blood pressure (hypertension), diabetes, obesity, or a family history of heart disease.
- Men over 40 years of age.
- Post-menopausal women.
- People who suffer from phenylketonuria should be aware that Maxalt melt tablets contain aspartame, which is a source of phenylalanine.
Not to be used in
- Severely decreased kidney function.
- Severely decreased liver function.
- People who have had a heart attack.
- Heart disease caused by inadequate blood flow to the heart (ischaemic heart disease), eg angina.
- A severe form of angina pectoris, not caused by exertion (Prinzmetal's angina).
- Narrowing of blood vessels in the extremities (peripheral vascular disease), eg problems with blood circulation in the legs or arms.
- Uncontrolled or moderate to severe high blood pressure (hypertension).
- People who have had a stroke.
- History of small temporary strokes (transient ischaemic attacks).
- A form of migraine associated with temporary paralysis of one side of the body (hemiplegic migraine).
- A type of migraine where there is a disturbance in brain function which initially presents with total blindness followed by dizziness, speach disturbances, ringing in the ears and double vision (basilar migraine).
- Maxalt tablets contain lactose and should not be taken by people with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption (this doesn't apply to Maxalt melt tablets).
- This medicine is not recommended for children and adolescents aged under 18 years, or people aged over 65 years, as there is no information available regarding its safety and effectiveness in these age groups.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- The safety of this medicine for use during pregnancy has not been established. It is not recommended for use in pregnancy unless considered essential by your doctor. Seek medical advice from your doctor.
- This medicine may pass into breast milk. It is not recommended for use during breastfeeding unless considered essential by your doctor. If you are breastfeeding and your doctor recommends you to take this medicine, you should avoid breastfeeding for 24 hours after taking the medicine, and any milk expressed during this time should be discarded. Seek further medical advice from your doctor.
- This medication may cause drowsiness. If affected do not drive or operate machinery.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
Common (affect between 1 in 10 and 1 in 100 people)
- Feeling weak or fatigued.
- Pins and needles or tingling sensations.
- Difficulty concentrating.
- Feeling of tightness or heaviness in the throat or chest.
- Shortness of breath.
- Chest pain (see warning section above).
- Awareness of your heartbeat (palpitations).
- Increased heart rate.
- Nausea and vomiting.
- Dry mouth.
Uncommon (affect between 1 in 100 and 1 in 1000 people)
- Blurred vision.
- Neck pain.
- Difficulty sleeping (insomnia).
- Increase in blood pressure.
- Sensation of spinning (vertigo).
- Rash or itching.
Rare (affect between 1 in 1000 and 1 in 10,000 people)
- Allergic reaction involving swelling of the face, tongue or throat (angioedema).
- Heart attack or stroke (mostly reported in people with risk factors for heart disease).
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.
This medicine should not be taken by people who are taking a monoamine oxidase inhibitor (MAOI), eg the antidepressants phenelzine, tranylcypromine, isocarboxazid or moclobemide, or the antibiotic linezolid, or who have taken one of these medicines in the previous two weeks. This is because these medicines may prevent the breakdown of rizatriptan in the body and thus increase the risk of its side effects.
Do not take this medicine if you have taken ergotamine or its derivatives, eg dihydroergotamine or methysergide, in the previous 24 hours. These medicines should not be taken within six hours of taking rizatriptan.
If your first dose of rizatriptan does not work to relieve your migraine, it is fine to take a painkiller containing aspirin, paracetamol, or a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen. However, as noted above, you should not take ergotamine, dihydroergotamine or methysergide for at least six hours after taking rizatriptan.
This medicine must not be taken in combination with other 5HT agonists (triptans), eg sumatriptan, zolmitriptan, frovatriptan, naratriptan, eletriptan, almotriptan.
There may be an increased risk of a rare side effect called the serotonin syndrome if rizatriptan is taken in combination with other medicines that enhance the activity of serotonin in the central nervous system, such as the following:
- selective serotonin reuptake inhibitor antidepressants (SSRIs), such as citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine or sertraline
- serotonin noradrenaline reuptake inhibitors (SNRIs), such as venlafaxine or duloxetine
- the herbal remedy St John's wort (Hypericum perforatum). This medicine is not recommended for use in combination with St John's wort.
The beta-blocker propranolol may increase the level of rizatriptan in the blood, increasing the risk of its side effects. Your doctor should prescribe you a lower dose of rizatriptan if you are taking propranolol. In addition, a dose of rizatriptan should not be taken within two hours of taking propranolol.
Other medicines containing the same active ingredient
There are currently no other medicines available in the UK that contain rizatriptan as the active ingredient.