Part of the Access Doctor migraine treatment guide. Conditions overview: migraine & headache UK.
Rizatriptan for Migraine: How It Works, Dose & Online Prescription UK
Clinically reviewed guide to rizatriptan (Maxalt) — faster onset and higher bioavailability than sumatriptan, the Maxalt Melt wafer, the critical propranolol interaction, and how to get it prescribed online.
▶ Rizatriptan at a glance
Rizatriptan (Maxalt) is a triptan for moderate to severe migraine with ~45% oral bioavailability and an onset of approximately 30 minutes — faster than sumatriptan. Standard dose is 10mg; reduce to 5mg if taking propranolol (mandatory interaction). Available as tablet and Maxalt Melt wafer (dissolves on tongue). Prescription-only. GPhC pharmacy #9011198.
~45%
Oral bioavailability (vs ~14% sumatriptan)
10mg
Standard dose (5mg if taking propranolol)
~30m
Onset of action
2h
Repeat dose interval if headache returns
How Rizatriptan Works
Rizatriptan is a selective 5-HT1B/1D receptor agonist that works by two mechanisms:
- Cranial vasoconstriction — constricts dilated intracranial blood vessels
- Trigeminal inhibition — blocks inflammatory neuropeptide release from trigeminal nerve terminals, interrupting the central pain signal
Rizatriptan’s higher oral bioavailability (~45%) compared to sumatriptan (~14%) means more active drug reaches the bloodstream, which is one reason it tends to have a faster and more consistent onset in many patients.
Dosing
| Situation | Dose | Notes |
|---|---|---|
| Standard first dose | 10mg at headache onset | Available as rizatriptan orodispersible tablet or Maxalt Melt wafer (dissolves on tongue — no water needed) |
| Taking propranolol | 5mg (not 10mg) | Propranolol increases rizatriptan plasma levels — mandatory dose reduction |
| Repeat dose if headache returns | 10mg (or 5mg with propranolol) after at least 2 hours | Only if the first dose produced initial relief |
| Maximum in 24 hours | 20mg (10mg if on propranolol) | Do not exceed. Do not repeat if first dose had no effect. |
Propranolol interaction — mandatory dose reduction: Propranolol inhibits the metabolism of rizatriptan, significantly increasing plasma levels. If you are taking propranolol (for migraine prevention or any other reason), you must use rizatriptan 5mg, not 10mg. This interaction is unique to rizatriptan — sumatriptan can be used at standard doses with propranolol.
Rizatriptan Maxalt Melt (Wafer)
Rizatriptan is available as a lyophilisate wafer (Maxalt Melt) that dissolves on the tongue without water. This makes it particularly useful during migraine attacks when nausea makes swallowing tablets difficult. The wafer formulation has the same pharmacokinetics as the tablet.
Rizatriptan vs Sumatriptan
The key practical differences: rizatriptan has higher oral bioavailability (~45% vs ~14%) and faster onset (~30 minutes vs 30–60 minutes), and is available as the Maxalt Melt wafer for patients who struggle to swallow during an attack. Sumatriptan has the largest clinical evidence base and more available formulations (oral, nasal spray, subcutaneous injection). If you take propranolol, rizatriptan requires a dose reduction to 5mg; sumatriptan can be used at standard doses.
For a full three-way comparison of rizatriptan, sumatriptan and zolmitriptan across all key properties, see: Triptans for migraine UK: full comparison guide →
See the full triptans comparison guide for a three-way comparison of sumatriptan, rizatriptan, and zolmitriptan.
Who Should Not Take Rizatriptan
- Ischaemic heart disease or history of MI
- Uncontrolled hypertension
- Stroke or TIA history
- Basilar or hemiplegic migraine
- Concurrent MAOIs or within 2 weeks of stopping
- Severe hepatic impairment
Get Rizatriptan Prescribed Online
Our GPhC-registered prescribers can assess your suitability for rizatriptan. Short questionnaire, discreet next-day delivery. GPhC pharmacy #9011198.
Request Rizatriptan Prescription →Frequently Asked Questions
How quickly does rizatriptan work?
Rizatriptan typically begins working within 30 minutes of taking a dose. This faster onset (compared to sumatriptan at 30–60 minutes) makes it a preferred choice for patients who need quick relief or find sumatriptan slow to act.
What is the correct dose of rizatriptan?
10mg at headache onset for most people. If you are taking propranolol, you must reduce the dose to 5mg (mandatory). A repeat dose can be taken after 2 hours if the headache returns. Maximum 20mg in 24 hours (10mg if on propranolol).
What is Maxalt Melt?
Maxalt Melt is the brand name for rizatriptan lyophilisate wafer — a formulation that dissolves on the tongue without water. It is identical to the tablet in terms of dosing and pharmacokinetics. The wafer is particularly useful when nausea makes swallowing tablets difficult during a migraine attack.
Why is rizatriptan dose reduced with propranolol?
Rizatriptan is metabolised primarily by monoamine oxidase-A (MAO-A). Propranolol inhibits MAO-A, reducing rizatriptan clearance and significantly increasing its plasma levels. This requires a mandatory dose reduction to 5mg when rizatriptan is taken alongside propranolol. Sumatriptan is metabolised via a different pathway and does not have this interaction.
Is rizatriptan better than sumatriptan?
Neither is universally better. Rizatriptan has higher oral bioavailability and faster onset. Sumatriptan has the largest evidence base and more available formulations (including nasal spray and injection). Individual response varies — if one triptan is not effective, the other is worth trying.
References
- NICE. Headaches in over 12s: diagnosis and management. CG150.
- Ferrari MD et al. Oral triptans in acute migraine treatment. Lancet. 2001.
- NHS. Rizatriptan. nhs.uk/medicines/rizatriptan
- Tfelt-Hansen P. Propranolol and rizatriptan interaction. Cephalalgia. 2004.
Medical disclaimer: This article is for informational purposes only. Prescription migraine treatments require a clinical consultation. Always consult a qualified healthcare professional. In a medical emergency, call 999.