Rizatriptan - A review of its efficacy in the management of migraine

Rizatriptan is an orally active serotonin 5-HT1 receptor agonist selective for the 5-HT1B/1D subtypes. The efficacy of oral rizatriptan (5 or 10mg) has been demonstrated in large (n = 309 to 1746) well designed comparative trials with placebo and oral sumatriptan. Two hours postdose, rizatriptan 5 or 10mg, was more effective than placebo at producing pain relief or a pain free status, relieving migraine-associated symptoms and normalising functional ability, In general, rizatriptan 10mg appeared to be more effective than rizatriptan 5mg. However, recurrence rates with rizatriptan 5 and 10mg appeared to be similar to those with placebo. Patients were significantly more likely to achieve pain relief within 2 hours after receiving rizatriptan 5mg than sumatriptan 25mg and after rizatriptan 10mg than sumatriptan 50mg. This was also observed with rizatriptan 10mg compared with sumatriptan 100mg according to an age-adjusted and a prespecified per-protocol analysis. In general, rizatriptan was better than sumatriptan at relieving migraine-associated symptoms, particularly nausea, and in normalising functional ability depending on which doses were compared. The incidence of headache recurrence, time to onset of recurrence and the need for escape medication in nonresponders appeared to be similar between rizatriptan and sumatriptan. Over the 24 hours after the dose, rizatriptan 10mg improved the quality of life of patients with migraine compared with placebo. Rizatriptan 10mg also significantly improved work function compared with placebo and with sumatriptan 50mg. Rizatriptan appears to be well tolerated with most adverse events being mild and transient. The most commonly experienced events included general digestive complaints, general neurological complaints, dizziness, somnolence, asthenia/fatigue and pain and pressure sensations, In clinical trials, the overall incidence of adverse events with rizatriptan 5 or 10mg was similar to that with sumatriptan 25 or 50mg but lower than that with sumatriptan 100mg, Chest pain was reported by 1 to 3% of rizatriptan recipients and by 3 to 6% of patients receiving sumatriptan (25, 50 or 100mg); clinically significant effects on ECG parameters, heart rate or blood pressure were not observed with rizatriptan, Conclusions: Rizatriptan produces pain relief and a pain free status, relieves associated symptoms of migraine, normalises functional ability and improves patient quality of life. Rizatriptan 10mg appears to be more effective than rizatriptan 5mg. In comparison with oral sumatriptan, rizatriptan may provide better relief from pain and nausea, with some evidence of a faster onset of action. Thus, rizatriptan 5 or 10mg is likely to establish a place as an effective and well tolerated agent for the management of acute migraine.