Rizatriptan contraindications

The P-blockers propranolol and timolol are FDA-approved for migraine prophylaxis, but other drugs in the class are also as effective.46 Cautious dosage titration is advised for those patients who do not have other indications for P-blocker use. Rizatriptan interacts with propranolol and thus dosages must be titrated downward, or another triptan chosen for abortive therapy.36 Comorbid reactive airway disease is a relative contraindication to P-blocker prophylaxis, and patients with cardiac conduction disturbances should be closely monitored. Calcium channel antagonists are often used when patients cannot tolerate P-blockers. They are purported to beneficially... 

CAD, CHF, uncontrolled HTN ergot or 5HT agonist use within 24 hr hemi-plegic/basilar migraine. Specific contraindications Wofff-Parkinson-White syndrome (zolmitriptan) PVD (frovatriptan) MAO-A inhibitor use within 2 weeks (sumatriptan, rizatriptan, zolmitriptan, frovatriptan). 

The triptans are contraindicated in patients who have a history of ischemic or vasospastic CAD, cerebrovascular or peripheral vascular disease, or other significant cardiovascular diseases. Because triptans may cause an acute, usually small, increase in blood pressure (BP), they also are contraindicated in patients with uncontrolled hypertension. Naratriptan is contraindicated in patients with severe renal or hepatic impairment. Rizatriptan should be used with caution in patients with renal or hepatic disease but is not contraindicated in such patients. Sumatriptan, rizatriptan, and zolmitriptan are contraindicated in patients who are taking monoamine oxidase inhibitors. 

Moclobemide markedly inhibits the metabolism of rizatriptan, and approximately doubles the bioavailability of sumatriptan. The manufacturers contraindicate these triptans with moclobemide and non-selective MAOIs. Moclobemide modestly inhibited the metabolism of zolmitriptan but had no clinically significant effect on almotriptan or frovatriptan. 

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