Precautions and Warnings With Rizatriptan (Cont.)

• Rizatriptan has been reported to increase the risk of a heart attack or a life-threatening change in a person's heart rhythm (arrhythmia). You should not take rizatriptan if you have heart disease or a history of a heart attack or chest pain (see Maxalt and Heart Problems for more information). 

If you have risk factors for heart disease (see Heart Disease Risk Factors), it is also strongly recommended that you take your first dose of rizatriptan in your healthcare provider's office. This is so that your healthcare provider can monitor your heart. You should also have your heart checked periodically while taking rizatriptan.

• In some cases, a stroke or transient ischemic attack ("mini stroke") can be misdiagnosed as a migraine. Your healthcare provider should make sure you are not having a stroke, especially if you have never had migraines in the past (see Stroke Symptoms for more information on the symptoms of a stroke).
   
• If you have chest pain or tightness in the jaw or neck after taking rizatriptan, contact your healthcare provider immediately. These side effects are fairly common with rizatriptan and are not usually serious. However, your healthcare provider may need to make sure you are not having heart problems.
   
• Medications like rizatriptan can cause blood vessels in the arms, legs, colon (large intestine), and other locations to spasm. This can cause a decrease in blood flow to these areas. Symptoms will vary based on the location. For example, a spasm in the colon can lead to severe abdominal pain (or stomach pain) or bloody diarrhea.

• Taking rizatriptan with certain antidepressants, including selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs), can increase your risk of developing a dangerous group of symptoms called serotonin syndrome. Do not use rizatriptan with depression medications without first discussing it with your healthcare provider. Contact your healthcare provider immediately if you have any possible symptoms of serotonin syndrome, including:

• Confusion
• Seeing or hearing things that are not really there (hallucinations)
• A fast heartbeat (tachycardia)
• Feeling faint
• A fever
• Sweating
• Muscle spasms
• Difficulty walking
• Diarrhea.

• Rizatriptan can cause an increase in blood pressure. You should not take rizatriptan if you have untreated high blood pressure (hypertension).
   
• Rizatriptan may make some people drowsy or dizzy. You should not drive or operate heavy machinery until you know how rizatriptan affects you.
   
• Rizatriptan MLT tablets (but not regular rizatriptan tablets) contain phenylalanine. This is important for people with phenylketonuria, who must limit their phenylalanine intake.
   
• Rizatriptan is considered a pregnancy Category C medication. This means that rizatriptan may not be safe for use during pregnancy. Talk with your healthcare provider before using rizatriptan if you are pregnant (see Maxalt and Pregnancy for more information).
   
• It is not known if rizatriptan passes through breast milk. Therefore, if you are breastfeeding or plan to start breastfeeding, be sure to talk with your healthcare provider about this.
   
• Before taking rizatriptan, tell your healthcare provider if you have liver problems (including liver failure or cirrhosis) or kidney problems (including kidney failure). This is important because rizatriptan is removed from the body through the liver and kidneys.
   
• Rizatriptan can interact with certain other medications (see Drug Interactions With Rizatriptan).