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Maxalt-MLT (rizatriptan) Disease Interactions

There are 6 disease interactions with Maxalt-MLT (rizatriptan):

Major

5-Ht1 Agonists (Includes Maxalt-MLT) ↔ Cad Risk Factors

Severe Potential Hazard, High plausibility

Applies to: Hyperlipidemia, Smoking, Obesity, Diabetes Mellitus, History (Familial) - Ischemic Heart Disease, Menopausal Disorders

The group of drugs known as 5-hydroxytryptamine1 receptor (5-HT1) agonists can cause vasospastic reactions, including coronary vasospasm, peripheral vascular ischemia, and colonic ischemia. Rarely, serious adverse cardiac events including acute myocardial infarction, arrhythmia, cardiac arrest, and death have been reported within a few hours following the administration of 5-HT1 agonists, in some cases even in patients with no prior history or findings of coronary artery disease (CAD). Significant elevation in blood pressure, including hypertensive crisis, has also been reported on rare occasions in patients with and without a history of hypertension, as have transient increases in blood pressure and peripheral vascular resistance. In general, patients with potentially unrecognized CAD as predicted by the presence of risk factors (e.g., hypertension, hypercholesterolemia, tobacco use, obesity, diabetes, strong family history of CAD, female with surgical or physiological menopause, or male over 40 years of age) should not be administered 5-HT1 agonists unless a cardiovascular evaluation provides satisfactory clinical evidence indicating the lack of CAD, ischemic heart disease, or other significant underlying cardiovascular disease. As a precaution, the manufacturers recommend that the first dose be administered under medical surveillance in such patients, and that electrocardiographic monitoring be considered during the interval immediately following administration to help detect any asymptomatic cardiac ischemia that may occur. Periodic cardiovascular evaluations should be performed during intermittent, long-term use.

References

  1. Mueller L, Gallagher RM, Ciervo CA "Vasospasm-induced myocardial infarction with sumatriptan." Headache 36 (1996): 329-31
  2. Kelly KM "Cardiac arrest following use of sumatriptan." Neurology 45 (1995): 1211-3
  3. "Product Information. Axert (almotriptan)" Pharmacia and Upjohn, Kalamazoo, MI.
View all 23 references
Major

5-Ht1 Agonists (Includes Maxalt-MLT) ↔ Cardiovascular Disease

Severe Potential Hazard, High plausibility

Applies to: History - Myocardial Infarction, Cardiovascular Disease, Cerebral Vascular Disorder, History - Cerebrovascular Disease

The use of 5-hydroxytryptamine1 receptor (5-HT1) agonists is contraindicated in patients with a current or past history of ischemic cardiac, cerebrovascular, and/or peripheral vascular diseases. In addition, these agents should not be used in patients with significant underlying cardiovascular diseases or uncontrolled hypertension. 5-HT1 agonists can cause vasospastic reactions, including coronary vasospasm, peripheral vascular ischemia, and colonic ischemia. Rarely, serious adverse cardiac events including acute myocardial infarction, arrhythmia, cardiac arrest, and death have been reported within a few hours following the administration of 5-HT1 agonists, in some cases even in patients with no prior history or findings of coronary artery disease (CAD). Significant elevation in blood pressure, including hypertensive crisis, has also been reported on rare occasions in patients with and without a history of hypertension, as have transient increases in blood pressure and peripheral vascular resistance. Cerebrovascular events have included cerebral hemorrhage, subarachnoid hemorrhage, and stroke, some resulting in fatalities. However, the relationship to 5-HT1 agonists is uncertain and, in a number of cases, the cerebrovascular events may have been primary where symptoms were mistaken to be migraine.

References

  1. Ottervanger JP, Paalman HJ, Boxma GL, Stricker BH "Transmural myocardial infarction with sumatriptan." Lancet 341 (1993): 861-2
  2. Kelly KM "Cardiac arrest following use of sumatriptan." Neurology 45 (1995): 1211-3
  3. "Product Information. Axert (almotriptan)" Pharmacia and Upjohn, Kalamazoo, MI.
View all 23 references
Major

Rizatriptan (Includes Maxalt-MLT) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Rizatriptan is primarily metabolized by the liver. Following oral administration in patients with alcoholic cirrhosis of the liver, the plasma concentrations of rizatriptan were not significantly altered in patients with mild hepatic impairment but were approximately 30% higher in patients with moderate hepatic impairment compared to healthy controls. Therapy with rizatriptan should be administered cautiously in patients with significantly impaired hepatic function. A lower initial dosage may be appropriate.

References

  1. "Product Information. Maxalt (rizatriptan)." Merck & Co, Inc, West Point, PA.
Major

Rizatriptan (Includes Maxalt-MLT) ↔ Migraines

Severe Potential Hazard, Moderate plausibility

Applies to: Migraine

The use of rizatriptan is contraindicated in patients with hemiplegic or basilar migraine.

Moderate

Rizatriptan (Includes Maxalt-MLT) ↔ Pku

Moderate Potential Hazard, High plausibility

Applies to: Phenylketonuria

Maxalt-MLT (brand of rizatriptan) orally disintegrating tablets contain 1.05 mg and 2.10 mg of phenylalanine per each 5 mg and 10 mg tablet, respectively. The phenylalanine content should be considered when these products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).

References

  1. "Product Information. Maxalt (rizatriptan)." Merck & Co, Inc, West Point, PA.
Moderate

Rizatriptan (Includes Maxalt-MLT) ↔ Renal Dysfunction

Moderate Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Rizatriptan is excreted in the urine primarily as metabolites but also as unchanged drug. Following oral administration in patients with renal impairment (CrCl = 10 to 60 mL/min/1.73 m2), the plasma concentrations of rizatriptan were not significantly altered compared to healthy controls. In hemodialysis patients (CrCl < 2 mL/min/1.73 m2), however, the area under the plasma concentration-time curve (AUC) was approximately 44% greater than that in controls. Therapy with rizatriptan should be administered cautiously in dialysis patients and patients with significantly impaired renal function. A lower initial dosage may be appropriate.

References

  1. "Product Information. Maxalt (rizatriptan)." Merck & Co, Inc, West Point, PA.

Maxalt-MLT (rizatriptan) drug Interactions

There are 61 drug interactions with Maxalt-MLT (rizatriptan)

Maxalt-MLT (rizatriptan) alcohol/food Interactions

There are 2 alcohol/food interactions with Maxalt-MLT (rizatriptan)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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