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Maxalt (Rizatriptan) Side Effects & Adverse Reactions (List)

Maxalt (Rizatriptan) is a pharmaceutical medication engineered by Merck & Co. for the treatment of migraine headaches (with or without aura).  It received FDA approval in 1998 as an abortive antimigraine intervention and is chemically classified as a second-generation triptan (tryptamine-based).  Analogous to other triptans, Rizatriptan remains ineffective as a migraine prophylactic, however, it is commonly prescribed off-label with success for the attenuation of cluster headaches.

When ingested, Rizatriptan acts as a serotonin receptor agonist, principally targeting the 5-HT1B and 5-HT1D receptor sites.  Agonism of the 5-HT1B and 5-HT1D receptors elicits a vasoconstrictive effect throughout intracranial blood vessels to counteract the disproportionate vasodilation implicated during migraine attacks.  Some speculate that the drug may also interfere with release of CGRP (calcitonin gene-related peptide) and other proinflammatory neuropeptides that are known to induce neurogenic inflammation, which in turn leads to a migraine.

A majority of individuals using Rizatriptan will attain significant therapeutic migraine relief within 30-90 minutes of administration.  Despite the therapeutic migraine relief often derived from this medication, a subset of users will report noticeable side effects.  For those currently using Rizatriptan, it is important to remain cognizant of all potential adverse reactions and evaluate whether the benefits outweigh unwanted side effects.

Maxalt (Rizatriptan) Side Effects & Adverse Reactions (List)

Included below is an extensive overview of possible side effects and adverse reactions that may occur while taking Rizatriptan.  Understand that specific side effects, number of side effects, and severity of side effects experienced will be largely subject to significant individual variation.  In other words, the side effects that you experience while taking Rizatriptan may be entirely different than those reported by another user.

That said, certain side effects tend to occur with greater frequency among users than others.  According to the Rizatriptan product information pamphlet provided by Merck & Co. the most common side effects in adults include: chest pain/pressure, dizziness, sleepiness/tiredness, and throat pain/pressure.  Other popularly reported side effects are: burning sensations, irregular heartbeat, and shortness of breath.

Allergic reaction: In extremely rare cases, users may experience allergic reactions to Rizatriptan.  Allergic reactions may be characterized by a rash with hives (localized or widespread) and/or swelling of body parts (e.g. neck, tongue, throat).  Should you suspect that you’re experiencing an allergic reaction, it is imperative that you contact emergency medical services for an evaluation.

Sometimes allergic reactions are serious enough as to cause long-term medical complications, or could be fatal.  If you are allergic to this particular antimigraine treatment, your doctor will likely be able to come up with some viable alternative interventions.  Fortunately, a majority of Rizatriptan users are unlikely to be allergic and won’t need to deal with the associated complications.

Anxiety: A relatively uncommon, yet reported side effect of Rizatriptan is anxiety.  It is understood that Rizatriptan modulates serotonergic activity to elicit its antimigraine effect.  However, since the serotonin system is implicated in anxiety disorders, it could be that the modulatory effect provokes anxiety – especially among those with an underlying susceptibility.

Those with a history of psychiatric disorders, specifically anxiety disorders – may experience an exacerbation of symptoms.  Then again, even those without chronic anxiety prior to taking Rizatriptan may suddenly become more anxious than usual.  If you feel anxious during treatment, talk to your doctor about it and determine whether anything can be done to reduce it.

Balance / coordination deficits: Certain users have conveyed that this medication has made them feel extremely intoxicated to the extent that their fine motor skills (balance, coordination, etc.) are compromised.  For this reason, it’s probably not a good idea operate a motor vehicle or utilize heavy machinery (e.g. power tools) while under the influence of Rizatriptan.  Additionally, you may want to temporarily avoid tasks that require optimal balance and coordination such as playing sports or working out.

Some users may find that as they continue using Rizatriptan, they’re better able to cope with motor skill deficits.  However, others may find that the longer they’ve used the drug, the worse their balance and coordination become (while under its influence).  If balance and/or coordination deficits are severe – you may want to ask your doctor about an ameliorative adjunct or whether it would be smart to use another medication.

Blurred vision: Within minutes of Rizatriptan taking effect, many users feel as if their vision becomes blurred, clouded, and/or fuzzy.  Although the drug isn’t likely damaging a person’s actual eyes, those in-need of reassurance should consult an ophthalmologist.  To cause blurred vision, the drug is likely altering blood flow (by constricting blood vessels) as well as neurotransmission.

The combination of blood flow changes along with serotonergic modulation, particularly in the visual cortex, could certainly provoke fuzzy vision.  The blurred vision in combination with motor skill deficits may make you feel somewhat drunken and ill-equipped to do much of anything.  Luckily the blurred vision often clears up within several hours after administration.

Burning sensation: Some users claim that their most debilitating side effect from Rizatriptan is a potent burning sensation.  The sensation of burning can occur in any region of the body, but is most often reported in the head and/or scalp.  Post-administration sensations of burning may last anywhere from minutes to hours, but will inevitably subside as the medication is cleared from systemic circulation.

Usually the relief from migraines outweighs some minor burning, but if the burning becomes severe, users may contemplate testing another triptan and/or non-triptan intervention.  In some cases, users may find that a dosage reduction decreases the severity of burning.  Other times, nothing can be done to mitigate the burning that results from Rizatriptan.

Chest pain: Among the most common Rizatriptan side effects is chest pain and/or pressure.  It may feel as if a wave of pain/pressure suddenly hits the chest area and remains for awhile as the drug takes effect.  The chest pain may lead some individuals to believe that they’re experiencing a heart attack – especially if accompanied by other symptoms.

That said, chest pain as a side effect should be taken seriously because it could be a sign of a heart attack in select users.  It is thought that Rizatriptan may constrict peripheral blood flow to the heart, thereby causing cardiac events and/or complications.  Any individual with suspected cardiac abnormalities should be carefully evaluated by a medical professional (cardiologist) during treatment.

Cognitive impairment: A troubling side effect that occurs in many Rizatriptan users is cognitive impairment.  As soon as the drug takes effect, most users notice a significant decline in their executive function characterized by poorer attention span, inability to memorize information or retrieve memories, and difficulties verbalizing thoughts.

For those who rely on optimal executive function in occupational and/or academic settings, the cognitive impairment resulting from Rizatriptan may be highly problematic.  If you’re unable to perform well on tests and/or remain productive at work while medicated, this should be discussed with your doctor.  Sometimes a dosage adjustment and/or stimulatory agent (e.g. caffeine) may be capable of ameliorating some drug-induced cognitive impairment.

Depression: Another fairly uncommon side effect associated with Rizatriptan, but one that should be mentioned is depression.  If you become increasingly depressed each time you take Rizatriptan, it’s likely more than just a coincidence – especially if you have an inherently upbeat demeanor.  The depression caused by Rizatriptan may be related to its agonism of serotonin receptors.

It is known that modulating serotoninergic processes can provoke depressive symptoms, especially among individuals with certain genotypes.  Furthermore, this serotonergic modulation may exacerbate depressive symptoms among those with an underlying diagnosis of major depressive disorder.  Monitor your mood while taking Rizatriptan and be sure to communicate any deleterious changes (e.g. depression) with your doctor.

Dizziness: Arguably the single most common side effect of Rizatriptan is dizziness.  Some users feel mildly dizzy, while others may experience severe dizziness lasting for several hours after administration.  To cope with the dizziness, you may want to take it easy and lie down on a bed or rest/relax on some comfortable furniture until it subsides.

You may end up experiencing vertigo or a profound spinning sensation accompanied by balance problems.  In certain cases, severe dizziness may be caused by taking too high of a Rizatriptan and/or an interaction with another medication.  If you feel incapacitated with dizziness each time you use Rizatriptan for your migraine, understand that you could consider alternatives.

Drowsiness: Once Rizatriptan fully kicks in, nearly all users report feeling a little bit drowsier than usual.  The drowsiness is often easily noticed and may be a direct cause of motor deficits and/or cognitive impairment resulting from treatment.  Some users have gone as far as to suggest the drowsiness induced by the medication is so extreme that they feel a combination of spaced out and/or high.

An easy way to deal with the drowsiness is to simply sleep it off.  If you have a migraine attack at night and administer Rizatriptan, the drowsiness as a side effect may serve as a smooth transition to a good night’s sleep.  That said, if the drowsiness occurs during a work or school day – it may be more challenging to cope with.  Perhaps some extra caffeine content could mitigate some of the drowsiness.

Dry mouth: Some Rizatriptan users will report dry mouth (xerostomia) as a side effect.  This is likely caused as a result of the medication interfering with generation of saliva via the salivary glands.  Since the dry mouth resulting from Rizatriptan isn’t generally severe and is transient, most will only consider it a minor annoyance.

Those experiencing this side effect may find it helpful to drink extra water and/or chew gum, the latter of which may stimulate a bit of additional saliva production to moisten the oral mucosa.  In extreme cases, dry mouth could provoke halitosis (bad breath) due to the fact that insufficient saliva generation allows bad bacteria to proliferate.  Overall, most users find the migraine relief to outweigh the minor dry mouth.

Frequent urination: Another side effect that some users may experience is frequent urination.  Although your migraine may have improved from Rizatriptan, you may also find yourself rushing to the bathroom more often than usual to empty your full bladder.  Many users have reported consciously noticing that as soon as their migraine is attenuated from the treatment, they feel an urge to frequently urinate.

Some believe that this medication has a diuretic effect that remains underreported in the literature.  Since effect of the medication only lasts for several hours, the frequent urination is unlikely to be long-lasting.  Obviously you may want to cut back on drinking excessive amounts of liquids – as this may exacerbate the problem.

Headaches: Isn’t it ironic that a person can take Rizatriptan for migraines, yet experience headaches as a side effect? Headaches are a relatively common and well-documented side effect of Rizatriptan, as well as other triptans.  Headaches may be caused as a result of changes in intracranial blood flow and/or slightly too much vasoconstriction of intracranial blood vessels.

The greater the extent to which intracranial blood vessels are constricted from the medication, the more severe the headache may be.  In most cases, headaches as a side effect are considered mild and are much more tolerable than an actual migraine.  However, it is important to mention that headaches can become chronic and/or intense among those who use Rizatriptan excessively.

Heaviness sensation: Rizatriptan users may experience an overwhelming sensation of heaviness in various regions of the body while the drug exerts its effect.  Some users may feel heaviness in the chest area, while others may feel as if their arms and/or legs are the only regions affected.  This heaviness sensation may make it difficult to engage in any physically-demanding activities such as walking or lifting – especially if accompanied by muscle weakness.

For certain individuals the heaviness may subside in less than an hour, while for others it could last for several hours.  To cope with this heaviness, it may be helpful to simply relax for awhile and not force yourself to remain highly active.  Although this sensation may be unwanted, it’s usually not as unpleasant as other sensations such as burning or tingling.

High blood pressure: Due to the fact that Rizatriptan can cause high blood pressure, it is important to regularly monitor your blood pressure during treatment to ensure that it remains within a healthy range.  If the drug causes your blood pressure to spike too often, this could lead to hypertension-induced health problems.  Long-term high blood pressure is associated with conditions such as: heart disease, kidney failure, stroke, and vision loss.

Although a modest increase in blood pressure temporarily may not be problematic, if you’re using the drug frequently and with each use it’s causing a spike – health problems may ensue.  Those with a history of hypertension should be especially cautious about using this medication in the first place.  Always communicate changes in blood pressure to your doctor and ensure that he/she is informed of your blood pressure history.

Irregular heartbeat: Some users may experience a noticeably irregular heartbeat from Rizatriptan.  The irregular heartbeat may be a result of changes in blood flow to the heart as a result of nerve activity and/or blood vessel constriction.  For this reason, the drug is contraindicated among those with a history of cardiac events.

In some cases, an irregular heartbeat could be nothing more than a benign reaction to the drug.  However, anyone who notices this side effect should report it immediately and request a comprehensive cardiac screening to rule out a possible heart condition.  If all heart conditions are ruled out, it could be that an irregular heartbeat is also a result of anxiety – causing the heart to flutter or beat at abnormal intervals.

Jaw tightness: A very uncomfortable side effect experienced by some users is jaw tightness and/or pain.  Users have reported that the jaw pain can become extreme, almost as if you just took a few punches in a boxing match.  As a result of this intense jaw discomfort, some users may end up discontinuing the medication and/or requesting another treatment.

Some have compared the tightness to the medical condition known as lockjaw (trismus) in which the mouth is unable to fully open.  This tightness may make it difficult for some individuals to swallow foods and/or drink water.  Since not much can be done to ameliorate the tightness, may be best to relax as much as possible until it subsides.

Lightheadedness: In addition to the common side effect of dizziness/vertigo, some may experience concurrent lightheadedness.  This lightheadedness may be a result of changes in cranial blood vessel size and/or could be related to changes in blood pressure.  Some individuals may become so lightheaded that they need to lie down and close their eyes, yet others may only feel slightly lightheaded.

If you feel lightheaded during treatment, it’s probably a good idea to avoid excessive physical activity such as running, jumping, lifting, or biking – as this may exacerbate the feeling.  In severe cases, some doctors may recommend a slight dosage reduction to determine whether the lightheadedness improves.  Nonetheless, lightheadedness usually trumps a severe migraine and is thus not considered too bothersome.

Nausea: Feeling nauseous is fairly common among Rizatriptan users.  The nausea may be at its worst if you take the drug on an empty stomach, possibly resulting from irritation of the gastrointestinal tract.  Nausea may improve if you decide to take the drug with a meal and/or snack.

To combat the nausea, users may want to ask their doctor about whether it would be safe to utilize an antiemetic agent.  Most will find that the nausea from Rizatriptan is mild and not extreme enough as to provoke vomiting.  That said, the nausea may temporarily reduce appetite – making it difficult to eat anything within several hours of taking the medication.

Neck tightness: Don’t be surprised if your neck feels stiff within an hour or so of taking Rizatriptan.  The stiff neck will eventually subside, but may seem as if it’s going to last forever.  Some may find it helpful to lie down and/or have a partner gently massage the neck area, while others may consider it too painful to even receive a massage.

It may also help to ensure that the neck is positioned on comfortable pillows while lying down.  Anyways, some have suggested that the stiff neck from the medication makes it challenging to relax and even fall asleep.  The neck tightness may be accompanied by a sensation of pressure and/or numbness.

Numbness: Many individuals have reported feeling numbness throughout their body as a result of Rizatriptan.  Numbness may occur in specific areas of the body such as the head, arms, neck, and/or chest – and could be accompanied by tingling sensations.  One theory is that the drug alters blood vessel size to such an extent, that blood flow is restricted to certain regions and numbness results.

Whether the theory of restricted blood flow to certain regions has any credibility isn’t understood.  Another possibility is that activity of sensory nerve fibers is affected, leading some users to feel numbness in select areas.  Though the bizarre sensation of numbness may be highly disconcerting, it often diminishes within a few hours.

Shortness of breath: Among some Rizatriptan users, shortness of breath is experienced as a side effect.  It may feel as if you’re struggling to inhale adequate oxygen, which may also lead to anxiety, lightheadedness, as well as possible hyperventilation.  If you’re experiencing shortness of breath, it is important to get in touch with your doctor as soon as possible to rule out any other deleterious medical complications and/or adverse reactions (e.g. cardiac events).

It is also possible that shortness of breath is a sign that you’re allergic to Rizatriptan.  Assuming that shortness of breath isn’t considered dangerous by your doctor, it may help to engage in some sort of relaxation exercise (such as paced-breathing).  For most individuals, the shortness of breath that occurs during treatment isn’t overly alarming.

Sleep disturbances: You may take Rizatriptan and feel really drowsy, tired, and fatigued – yet find yourself unable to get a quality night’s sleep.  Any drug that significantly alters neurotransmission has potential to disrupt a person’s sleep; this drug modulates serotonin receptor activity.  Some users may report weird dreams on the nights that they administer Rizatriptan, while others may feel as if they’re unable to get deep, restorative sleep.

If you wake up feeling extremely groggy and/or fatigued after a full night’s sleep on the days you use Rizatriptan, it’s possible that the drug is affecting your brain waves, rapid-eye-movement (REM), and time spent in various sleep stages.  It could also be that the drug is affecting your circadian rhythm, leaving you to feel groggier than usual upon waking.  Those who experience sleep abnormalities on days of treatment may want to discuss concerns with a doctor and sleep specialist.

Stomach pain:  While most people report some sort of chest pain and/or pressure after taking Rizatriptan, another common reaction to the drug is stomach pain.  Some individuals may report a mild stomach ache, while others may report severe pain to the extent that it’s difficult to cope.  In certain cases, it is possible that the stomach pain is caused by irritation of the gastrointestinal tract, while in other cases, it may be a result of activational alterations within the peripheral nervous system.

Since stomach pain can result from taking the drug on an empty stomach, certain users may find it beneficial to eat a small snack and/or meal with the drug.  Concurrent food consumption with the medication can modulate absorption to such an extent that stomach pain is ameliorated.  If eating a small snack doesn’t seem to improve the stomach pain, you may want to talk to ask your doctor whether he/she has other recommendations to help you cope.

Sweating: After administering Rizatriptan and getting relief from your migraine headache, you may notice that you’re sweating more than usual.  Some may only notice a minor sweat, while others may sweat profusely and completely drench their clothes.  The sweating could be embarrassing for some individuals, especially those who have a history of generating too much sweat.

Though it isn’t clear exactly how Rizatriptan may cause hyperhidrosis (excessive sweating), it must activate the sweat glands.  If you know that the drug causes you to sweat each time you take it, brace yourself by changing out of nice clothes.  You may also want to increase consumption of water to offset the lost water via sweats.

Throat pain: Some individuals have reported burning inside of their throats following Rizatriptan ingestion, while others have reported throat pain and/or pressure.  While it may not feel like you have strep throat, it may feel like your throat is about to explode and/or as if it is aching with a dull pain.  The throat pain may last anywhere from minutes to hours after administration – but usually has completely ceased within 4 hours.

It may be a good idea to simply rest your neck and gently massage your throat.  It may also help to understand that the throat pain is likely of mild intensity compared to the migraine that you were experiencing.  Realize that the throat pain will not last forever and may not occur every single time you administer Rizatriptan.

Tingling sensations: An odd sensory reaction to Rizatriptan that is commonly reported by users is bodily “tingling.”  The tingling may be accompanied by sensations of numbness and/or burning – possibly resulting from changes in blood flow and/or blood vessel size within the peripheral nervous system.  Tingling may also occur as a result of altered activity of peripheral nerve fibers resulting from the drug.

You may experience tingling in one specific region, but it may also be widespread.  Some have described the tingling as feeling like pins and needles underneath the skin, while others have suggested that it feels more like brief prickles and/or stings. Regardless, these tingles are usually nothing more than a bizarre sensation occurring in response to the medication.

Tiredness: Taking Rizatriptan may make you feel extremely tired and drowsy to such an extent that you feel the urge to nap.  Although tiredness may be perceived as an advantageous side effect at nighttime if you’re struggling to wind down and get some sleep, if you have a midday migraine and feel sluggish from the medication – it may be a problem.  Many individuals with migraines are in school and/or working in professional settings – and need to remain alert an energetic.

The tiredness may interfere with productivity and/or motivation at a particular job.  To cope with the tiredness, you may want to ask your doctor about utilizing a stimulatory adjunct or drinking a cup of coffee.  Caffeine may not only serve as an adjunctive antimigraine therapy, but may help offset the drug-induced tiredness caused by Rizatriptan.

Vomiting: In rare cases, some individuals may become so nauseous during treatment with Rizatriptan that they vomit.  If you ever end up vomiting during treatment, it is imperative that you inform your doctor as soon as possible; it could be the sign of something serious.  Vomiting is considered an extreme adverse reaction that is unlikely to occur in a majority of Rizatriptan users.

If you’re feeling nauseous, and the nausea is what’s provoking the vomiting, you may want to consider testing whether eating some food (e.g. a snack) can help offset the drug-induced nausea.  You may also want to inquire your doctor about whether its safe to take an antiemetic agent with Rizatriptan; an antiemetic may prevent both nausea and vomiting.  A dosage reduction may benefit certain individuals, but if you’re vomiting each time you take the drug – it may be smartest to pursue other options.

Weakness: Feeling extremely weak can occur for a duration of several hours after taking Rizatriptan.  It may feel as if all of the energy has been sucked out of your body, and your muscles may feel as if they’ve instantly atrophied.  This may be problematic for those who wish to remain physically active and productive throughout the day.

However, with any medication, there’s going to be somewhat of a tradeoff – you get relief from your migraine and end up dealing with some unwanted side effects such as feeling temporarily weak.  The perceived weakness may stem from changes in sensory nerve activation and/or the side effect of drowsiness.  Drinking some caffeine may give you a bit of energy to help offset some of the weakness.

  • Source: http://www.merck.com/product/usa/pi_circulars/m/maxalt/maxalt_ppi.pdf

Note: If you have any questions regarding any specific side effects, it is recommended to immediately contact a medical professional.

Variables that influence Maxalt (Rizatriptan) side effects

Whenever contemplating side effects you’re likely to experience on Maxalt, it is necessary to consider variables that are most likely to influence side effect severity and occurrence.  These variables may help explain why one person experiences different side effects and/or more severe side effects than another individual.  The most prominent variables in regards to influencing side effects include: drug dosage, co-administered agents, frequency/term of administration,

  1. Dosage (High vs. Low)

Medical literature indicates that the recommended dosage of Maxalt as an abortive migraine therapy is either 5 mg or 10 mg.  Prescribing documentation suggests that although the 10 mg dose may be more effective for treating migraines, it also carries greater risk of adverse reactions.  In general, the greater the dosage a person takes to treat their migraine, the more likely they are to experience side effects, as well as side effects of greater severity (compared to lower doses).

Ingestion of a high dose means that more of the drug will enter systemic circulation and necessitate absorption, metabolism, and distribution.  Certain side effects may only occur or become noticeable at higher doses compared to lower ones.  It makes logical sense that side effects occur more often at high doses due to the fact that a 10 mg dose is double that of a 5 mg dose, possibly exerting 2-fold the neurophysiological effect (by comparison).

The serotonin receptor (5-HT1D and 5-HT1B) agonism provided by Maxalt may be doubled, and homeostatic processes may also be disrupted to a greater extent, thereby increasing susceptibility to side effects.  For this reason, most people can expect to experience more prominent side effects from a 10 mg dose than a 5 mg one. Anyone taking supratherapeutic doses (above 10 mg) will be more likely to experience an adverse reaction, whereas individuals ingesting subtherapeutic doses (below 5 mg) may not notice any substantial side effects.

  1. Co-administered substances

Although Maxalt doesn’t interact with may substances pharmacokinetically, its metabolism can be altered by those taking MAOIs.  Maxalt is metabolized primarily by MAO-A (monoamine oxidase A) enzymes, and if administered following ingestion of an MAOI, plasma concentrations of Rizatriptan may be increased – especially if the MAOI is a selective MAO-A inhibitor.  Essentially, an MAOI can prevents monoamine oxidase-A enzymes from breaking down neurotransmitters and drugs like Rizatriptan.

As a result of the lack of metabolic breakdown, it is likely that plasma concentrations will increase to such an extent that users may be more prone to severe adverse reactions.  Studies have shown that administration of a selective reversible MAO-A inhibitor (Moclobemide) increases maximum plasma concentrations of Rizatriptan by 41% and its N-monodesmethyl metabolite by over 400%.  Researchers believe that the plasma increases would be even more substantial with an irreversible MAO-A inhibitor.

Those taking MAOIs should discuss the possibility of interactions with their doctor.  In addition to pharmacokinetic interactions with MAOIs, certain drugs may exacerbate side effects as a result of their pharmacodynamics.  Any substance that modulates serotonergic activity such as an SSRI theoretically could provoke “serotonin syndrome” – an adverse reaction documented in the literature.  Other CNS depressants such as alcohol may be dangerous to take along with Rizatriptan and may exacerbate side effects.

That said, certain substances such as caffeine may ameliorate some side effects experienced during treatment.  For example, if you feel drowsy while taking Rizatriptan, yet drink a big cup of coffee after its administration, you may end up not experiencing any drowsiness or fatigue.  Therefore, it is important to evaluate whether certain drugs and/or supplements may actually be offsetting certain drug-related side effects.

  1. Frequency/Duration of Administration

The frequency at which you administer Maxalt, as well as the cumulative term of administration may influence the side effects that you experience.  Some users report that when they administer the drug on an infrequent basis, their side effects are less likely to occur than if they take it frequently.  Others may report the exact opposite – the more they take the drug, the less noticeable the side effects become.

Among the frequent users who notice a reduction in side effects as a result of frequent usage, it could be that the body has learned to regularly accommodate the presence of Rizatriptan.  As a result of this accommodation, side effects that were pronounced early in treatment become less severe and/or may diminish altogether.  On the other hand, those who use the drug infrequently and notice a lot of side effects may never fully adjust to the effects of the drug.

The lack of neurophysiological adaptation may lead users to experience numerous side effects with each ingestion.  Conversely, some infrequent users may report fewer overall side effects, possibly resulting from the fact that they’re using a lower dose and/or administering the drug less frequently; this leads to a smaller disruption in homeostasis and ultimately fewer side effects.  All that said, the literature has noted that the side effect of rebound headaches often becomes worse among high-frequency users.

In addition to frequency of administration, sometimes the cumulative term (or duration) over which the drug has been administered can also influence side effects.  Those that have been using Maxalt for an extended duration may end up with long-term unwanted side effects or a worsening of side effects over time – possibly resulting from tolerance and ensuing dosage increases.  On the other hand, short-term users may experience less noticeable side effects because the cumulative neurophysiological changes induced by the drug are less.

It could also be that short-term users are more likely to experience certain side effects because their bodies have not learned to accommodate the drug.  On the other hand, long-term users may be less likely to experience side effects, hence the reason they’ve used it for a long-term.  When assessing side effects, consider the interplay between frequency and term of administration, as well as the individual.

  1. Individual factors

Two users could take Maxalt at the same dosage, with the same set of co-administered substances (or lack thereof), at identical intervals of frequency and duration – yet side effects may still differ.  One person may complain of excessive dizziness and nausea, while another may complain more of tingling sensations and muscle weakness.  In this case, the differences in side effects can be explained by individual factors such as: administration details, genetics/epigenetics, medical conditions, sleep, and stress.

  • Administration details: The details regarding administration of Maxalt may determine whether a user is likely to experience side effects. For example, someone who takes the drug on an empty stomach in the morning may be more likely to experience nausea and/or stomach aches compared to those who take the drug on a full stomach in the evening.  Whether the drug is taken with or without food, as well as the time of day it is administered may determine some side effects.
  • Genetics/epigenetics: Not everyone has the same genes nor the same epigenetic expression. Our genes play a major role in determining how well we’re able to tolerate a certain drug.  Some people may be completely intolerant to Rizatriptan based on a particular gene and/or set of genes, whereas another may experience hardly any side effects resulting from a favorable set of genes.  Since Maxalt is metabolized by MAO, perhaps genes encoding for MAO enzymes could affect side effects.
  • Medical conditions: According to the manufacturers, Maxalt is contraindicated among those with a history of: heart disease, coronary artery vasospasm, stroke or transient ischemic attack, peripheral vascular disease, ischemic bowel disease, and uncontrolled hypertension. If you have any of these conditions, the consequences resulting from treatment may be substantial.  Furthermore, literature suggests that those with hepatic impairment or renal impairment may exhibit heightened plasma concentrations, possibly increasing side effects.  It should also be noted that those with medical conditions may be taking medications that are contraindicated with Maxalt or that facilitate interaction-related side effects.
  • Sex: There’s evidence suggesting that the AUC (area under the curve), as well as maximum plasma concentrations (Cmax) are greater in females taking a 10 mg dose compared to males. This suggests that female users may be slightly more prone to side effects as a result of the increases in Rizatriptan plasma.  Oppositely, males may be less likely to experience side effects and may be able to tolerate the 10 mg dosage better.
  • Sleep / Stress: Whether a person has been getting quality sleep and their overall stress level can influence drug-related side effects. In fact, someone who’s sleep deprived or overly stressed may suspect that the medication caused certain side effects, when in fact they were really caused by the sleep deprivation or excessive stress.  It could also be that medication-related side effects are exacerbated by a poor night’s sleep or high-stress.

Source: https://www.merck.com/product/usa/pi_circulars/m/maxalt/maxalt_pi.pdf

Maxalt (Rizatriptan): Do the antimigraine benefits outweigh the side effects?

If you’re currently taking Maxalt (Rizatriptan), it’s important to evaluate whether the antimigraine benefits outweigh the unwanted side effects resulting from treatment.  A subset of users may take Maxalt and report profound antimigraine benefits with zero noticeable side effects.  Not noticing any side effects and deriving therapeutic relief from a migraine headache would be considered a utopian response to treatment.

On the other hand, some users may derive zero benefit from the drug – even at high doses, plus experience an array of unwanted side effects.  If the drug is not working to alleviate a migraine and causing side effects – this could be regarded as a dystopian response to treatment.  Most users will fall somewhere between the aforestated utopian (all benefits no drawbacks) and dystopian (no benefit all drawbacks) examples.

Some estimates suggest that upwards of 80% of individuals will have success with using Maxalt as an abortive migraine therapy.  Among a majority of responders, some side effects will be noticeable, but they’ll be worth putting up with for the migraine relief.  For example, they may notice some minor dizziness, slight drowsiness, and/or slight pressure in various areas of the body – all of which are unwanted, but not overly debilitating.

On the other hand, some responders will enjoy the migraine reduction, but have an extremely difficult time coping with drug-related side effects.  These individuals may: struggle to maintain balance while walking, end up vomiting, and/or experience severe rebound headaches.  As a result, some users may decide that the side effects clearly outweigh the therapeutic benefit provided by the drug.

To accurately determine whether the benefit provided by Maxalt is superior to the drawbacks that may occur, you may find it helpful to write in a journal.  Journaling about your experiences with the drug over an extended duration will give you perspective as to whether your tolerability improves and/or worsens over time.  It will also provide you with information that you can share with your doctor in the event that you’d like to discuss any side effects.

Possible ways to reduce Maxalt (Rizatriptan) side effects

There are some possible ways in which you may be able to reduce side effects resulting from Maxalt (Rizatriptan).  Prior to ever implementing any of these side effect mitigation strategies, discuss their safety and hypothesized efficacy with a medical professional.  Some relatively obvious ways to decrease side effects include: dosage reduction, co-supplementation, taking Rizatriptan with food, avoiding unnecessary substances, fix sleep/stress, and/or continue using.

  1. Dosage reduction: As was already mentioned, the greater the dosage of Rizatriptan you take for migraines, the more significant the side effects will be. Sometimes users may start at the 10 mg dose without even trying the 5 mg dose to determine whether it would provide relief. The goal of treatment should be to take the “minimal effective dose” or lowest possible amount for a therapeutic response.  Those who can get away with 5 mg (or possibly less) for headache relief may be able to dramatically decrease side effects.
  2. Co-administered agents: Sometimes the dosage of Rizatriptan cannot be tweaked because it renders the drug ineffective for the treatment of migraines. In the event that side effects are pronounced, they should be evaluated and discussed with a doctor. Your doctor may be able to recommend some drugs or supplements that you can safely co-administer with Rizatriptan that may offset some of the unwanted side effects.  For example, caffeine administration may be useful to combat the drowsiness.
  3. Take with food: Those who aren’t taking Rizatriptan with food may want to try taking it with a meal and/or small snack. It is understood that food can slow its absorption by up to 1 hour without affecting its antimigraine effect. Some may find that food reduces certain gastrointestinal-related side effects such as nausea, vomiting, and stomach aches.
  4. Avoid unnecessary substances: Any individual taking an array of unnecessary supplements and/or drugs may want to stop taking them temporarily. Don’t stop taking any pharmaceutical without medical instruction, however, if you are taking substances that aren’t medically prescribed – realize that they may be causing interaction-related side effects. Sometimes cutting out unnecessary supplements can significantly improve perceived side effects of Maxalt.
  5. Improve sleep and stress: It is understood that poor sleep hygiene and high stress can exacerbate side effects associated with any drug. For this reason, you’ll want to ensure that you’re getting plenty of quality sleep each night. You’ll also want to engage in stress reduction to increase your ability to deal with drug-related side effects.
  6. Continue using: Certain individuals may find that Maxalt side effects are most significant the first few times it’s administered, but improve thereafter. If you just began treatment and are struggling with some side effects, understand that they may get better over time. It could be that you’ll benefit significantly from continued Rizatriptan usage.

Have you experienced Maxalt (Rizatriptan) side effects?

If you’ve taken Maxalt (Rizatriptan), feel free to leave a comment regarding any side effects you experienced.  Specifically mention any side effects that you consider most noticeable, as well as ones that you find to be most debilitating or least pleasant.  Also, if you experienced a side effect or adverse reaction that wasn’t mentioned in the article, report it in your comment.

In your experience, have you found that the therapeutic antimigraine effect provided by Maxalt trumps its side effects?  To help others get a better understanding of your situation, provide some additional information such as: Maxalt dosage, frequency/duration of usage, other drugs/supplements you take, and/or your medical conditions besides migraines.  If you’ve taken any other triptans or abortive migraine pharmaceuticals, how does Maxalt compare in terms of efficacy and tolerability?

Understand that it is important to always listen to your body in terms of how you react to Maxalt.  If you don’t react well to it, adverse reactions and side effects should be promptly communicated to your doctor.  Even if Maxalt isn’t a good fit for you as a migraine treatment, there remain plenty of other clinically effective (and possibly more tolerable) options.

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