Maxalt: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on Sep 25, 2023.

1. How it works

• Maxalt and Maxalt-MLT are brand (trade) names for rizatriptan which may be used to relieve the symptoms of a migraine.
• Maxalt (rizatriptan) and Maxalt-MLT work by binding to serotonin 5HT1B/1D receptors in the blood vessels and nerves of the brain and is thought to relieve migraine symptoms through inhibition of pro-inflammatory substances and a constriction of cranial blood vessels. Maxalt is used for acute migraine symptoms - ones that are happening now - and is not used to prevent a migraine headache or reduce the number of migraine headaches you may have over the long term.
• Maxalt belongs to the triptan class of medicines commonly used in migraine treatment. It may also be called a selective serotonin receptor agonist.

2. Upsides

• Effective for the acute treatment of migraine with or without aura in adults and children 6 years of age and older.
• Available as oral tablets (Maxalt) and orally disintegrating tablets (Maxalt-MLT). Maxalt-MLT tablets dissolve without water in the mouth.
• For adults, the dosage is 5 or 10mg as a single dose. Repeat doses must be separated by at least 2 hours. The maximum dose within 24 hours is 30mg.
• For children aged 6 to 17 years, the dosage is 5mg as a single dose in children less than 88 lb (40 kg) or 10mg as a single dose in patients 88 lb (40 kg) or more. It is not known if taking more than 1 dose of Maxalt in 24 hours is safe and effective in children.
• Available as Maxalt 10mg and Maxalt-MLT 10mg. To get a 5mg dose, break the tablet in half along the score line.
• Maxat and Maxalt-MLT will start to work for a migraine headache within 30 minutes for some patients. By 2 hours, there is a 60% to 70% chance of having a headache response (no pain or mild pain) in patients being treated with Maxalt or Maxalt-MLT.
• Maxalt does not contain caffeine.
• Generic Maxalt is available. There are 5 mg tablets available in the generic form.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Fatigue, drowsiness, pain/pressure sensation, and dizziness are the most commonly reported side effects, occurring in 5% or more people taking Maxalt or Maxalt-MLT. Other common side effects include a dry mouth, nausea, diarrhea, dyspnea, flushing, and warm sensations.
• A sensation of tightness, pain, pressure, or heaviness in the throat, neck, jaw, or over the heart has been reported by some people after taking Maxalt. This is a common occurrence and is usually not a sign of a heart problem. However, if you are at risk of heart problems, or if you are concerned in any way, you should see a doctor for an evaluation.
• Should not be taken by people who have a hypersensitivity, including angioedema or anaphylaxis, to Maxalt, rizatriptan, or any of the excipients in the tablets.
• Maxalt is not suitable for people with certain cardiovascular conditions including ischemic coronary artery disease (angina, history of myocardial infarction, or documented silent ischemia) or other significant underlying cardiovascular disease. Other contraindications include coronary artery vasospasm (Prinzmetal’s angina), uncontrolled high blood pressure, peripheral vascular disease, and ischemic bowel disease. A cardiac examination may need to be performed in those with multiple cardiovascular risk factors.
• 5-HT₁ agonists, such as Maxalt, have been associated with an increased risk of stroke, hemorrhage, or TIA; however, it is not clear whether this is due to the presence of migraine, or people mistaking stroke symptoms for those of a migraine. Do not take Maxalt if you have previously had a stroke or TIA.
• Although not associated with myocardial ischemia, those at high risk should be evaluated. Life-threatening arrhythmias have been reported within a few hours of administration of 5-HT₁ agonists, such as Maxalt. Discontinue if these occur.
• Maxalt should not be given to people who have recently taken (within the last 24 hours) another 5-HT1 agonist (such as sumatriptan), ergotamine-containing medication, or ergot-type medication. It should not be taken within 2 weeks of a MAO-A inhibitor
• Should only be used if a clear diagnosis of a migraine headache has been established. The diagnosis of a migraine will need to be reconsidered if the migraine attack does not respond to the first dose of Maxalt.
• Maxalt is not a preventive medicine and will not prevent future migraine attacks. Not indicated for the treatment of cluster headache, hemiplegic, or basilar migraine.
• It is not known if Maxalt is safe and effective in children less than 6 years of age.
• Overuse of acute migraine medications, including triptans, ergotamine, opioids, or OTC analgesics can lead to exacerbation of headache (medication overuse headache). These can present like daily migraine headaches. Talk to your doctor if you are experiencing daily migraines.
• May interact with several different drugs including ergot-containing drugs and those that increase serotonin (such as antidepressants, St Johns Wort, and antipsychotics). The dosage of Maxalt needs to be decreased if coadministered with propranolol.
• There is limited data regarding the use of Maxalt or Maxalt-MLT during pregnancy. Although the pregnancy registry for Maxalt did not report any pattern of congenital abnormalities or other adverse birth outcomes over a 20 year period, the data was limited and not comprehensive enough to detect an individual risk of birth defects. Animal studies have shown adverse effects on the fetus, such as fetal death, fetal abnormalities, and vascular defects. Use only if the risk outweighs the benefits. Use caution during breastfeeding. Minimize infant exposure by avoiding breastfeeding if Maxalt has been administered that day.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

• Maxalt is an oral tablet and Maxalt-MLT is an orally disintegrating tablet (dissolves without water in the mouth) and these may be taken by adults and children aged 6 and older to relieve the acute symptoms of a migraine. The most common side effects are fatigue, drowsiness, dizziness, and a sensation of tightness, pain, pressure, or heaviness in the throat, neck, jaw, or over the heart. The dose may be repeated after at least 2 hours by adults if necessary, but it is not known if a second dose is safe or effective in children and young adults under the age of 18.

5. Tips

• Start treatment as soon as you develop migraine symptoms or symptoms that typically occur with a migraine (such as nausea, vomiting, or sensitivity to light).
• For adults, the dosage is 5 or 10mg as a single dose. Repeat doses must be separated by at least 2 hours. The maximum dose within 24 hours is 30mg.
• For children aged 6 to 17 years, the dosage is 5mg as a single dose in children less than 88 lb (40 kg) or 10mg as a single dose in patients 88 lb (40 kg) or more. It is not known if taking more than 1 dose of Maxalt in 24 hours is safe and effective in children.
• Maxat and Maxalt-MLT will start to work for a migraine headache within 30 minutes for some patients. By 2 hours, there is a 60% to 70% chance of having a headache response (no pain or mild pain) in patients being treated with Maxalt or Maxalt-MLT.
• Maxalt-MLT 10mg tablets contain 2.1mg phenylalanine, a component of aspartame. Phenylketonurics should avoid Maxalt-MLT.
• Tell your doctor before taking Maxalt or Maxalt-MLT if you have or have had heart problems, a stroke or transient ischemic attack (TIA), high blood pressure, ischemic bowel disease, hemiplegic or basilar migraines, or an allergy to Maxalt or rizatriptan or any of the ingredients in Maxalt or Maxalt-MLT.
• Symptoms of a stroke or TIA may be easily mistaken for those of a migraine. A stroke tends to come on suddenly, whereas symptoms of a migraine with aura tend to evolve gradually over several minutes. The headache of a migraine also tends to intensify to a peak rather than instantaneously developing. Vision disturbances can be experienced during both a stroke or a migraine; however, other effects, such as flashing lights or zigzagging lines usually occur only with migraines. You may not realize your vision has been impaired with a stroke until you start bumping into things. It is rare for migraines to suddenly develop during adulthood; most people experience their first one in childhood. If you have any concerns at all that your symptoms may be those of a stroke, call 911 and seek immediate medical attention.
• See your doctor if you experience any side effects of concern such as changes in the color or sensation in your fingers and toes, sudden or severe stomach pain, weight loss, bloody diarrhea, cramping, cold or hot feelings in parts of your body, hives, or swelling of your tongue, mouth, or throat.
• Either a migraine, or treatment for a migraine, may cause drowsiness. Do not drive or operate machinery or perform other hazardous tasks if a migraine or its treatments make you drowsy.
• Overuse of acute migraine medications, including triptans, ergotamine, opioids, or OTC analgesics can lead to exacerbation of headache (medication overuse headache). These can present like daily migraine headaches. Talk to your doctor if you are experiencing daily migraines.
• Do not drink alcohol if you have taken a dose of Maxalt or Maxalt-MLT.
• Maxalt interacts with several other medicines including propranolol, other migraine medicines, and antidepressants. There is a risk of serotonin syndrome developing if too high a dosage of rizatriptan is used or other drugs are taken that also increase serotonin levels in the body. Symptoms include hallucinations, agitation, fast heartbeat, nausea, vomiting, diarrhea, and incoordination. Talk to your doctor or pharmacist before taking any other medication or herbal product that may interact with Maxalt. If you develop symptoms suggestive of serotonin syndrome, discontinue Maxalt and talk to your doctor straight away.
• Talk to your doctor if you are pregnant or intend to become pregnant before taking Maxalt or Maxalt-MLT. The benefits of taking the drug need to be weighed up against the risks. Do not breastfeed within a few hours of taking.

6. Response and effectiveness

• Peak concentrations of Maxalt were reached within 1 to 1.5 hours and peak concentrations of Maxalt-MLT were reached slightly later (delayed by up to 0.7 hours compared with Maxalt).
• In studies with Maxalt (rizatriptan), there was a 20% probability of achieving a migraine headache response (no pain or mild pain) with a 10 mg dose after 30 minutes compared to about 10% probability with the 5 mg dose or a placebo (an inactive pill).
• At 2 hours after taking a dose, the probability of a headache response increased to 65% to 70% in patients using Maxalt, compared to about 40% in the placebo group.
• In studies evaluating Maxalt-MLT, the orally-disintegrating form of Maxalt, there was a 20% probability of achieving a headache response (no pain or mild pain) with a 10 mg dose after 30 minutes compared to about 15% probability with the 5 mg dose and 10% probability with a placebo (an inactive pill).
• At 2 hours after taking a dose, the probability of a migraine headache response increased to 60% to 70% in patients using Maxalt-MLT, compared to about 35% in the placebo group.
• In all studies with Maxalt or Maxalt-MLT (5 or 10 mg), more patients achieved a significant headache response 2 hours after treatment when compared to the group taking a placebo.

7. Interactions

Medicines that interact with Maxalt or Maxalt-MLT may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with Maxalt. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Maxalt or Maxalt-MLT include:

• 5-hydroxytryptophan
• bromocriptine
• antidepressants, such as citalopram, desvenlafaxine, duloxetine, fluoxetine, mirtazapine, or nefazodone
• methylene blue
• monoamine oxidase inhibitors, such as isocarboxazid, phenelzine, or selegiline - Maxalt is contraindicated if these have been taken during the past 2 weeks
• ondansetron
• other migraine medications, such as dihydroergotamine, ergotamine, almotriptan, sumatriptan, or zolmitriptan - do not use Maxalt if any of these medications have been taken in the past 24 hours
• opioids, such as buprenorphine, codeine, fentanyl, oxycodone, methadone, morphine, or codeine
• propranolol - decrease the dose of Maxalt because propranolol has been shown to increase the plasma AUC of rizatriptan by 70%
• red yeast rice
• St John's wort
• tramadol
• venlafaxine.

Serotonin syndrome may occur with Maxalt or Maxalt-MLT, particularly with coadministration of SSRI antidepressants, SNRIs, tricyclic antidepressants, tramadol, or MAOI inhibitors. Symptoms may include hallucinations, agitation, fast heartbeat, nausea, vomiting, diarrhea, and incoordination.

Note that this list is not all-inclusive and includes only common medications that may interact with Maxalt or Maxalt-MLT. You should refer to the prescribing information for Maxalt or Maxalt-MLT for a complete list of interactions.

References

• Maxalt (rizatriptan benzoate) tablets, for oral use, Maxalt (rizatriptan benzoate) orally disintegrating tablets. Revised 06/2021. (Product Information). https://www.organon.com/product/usa/pi_circulars/m/maxalt/maxalt_pi.pdf

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Maxalt only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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