Rizatriptan Propranolol

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... 

Rizatriptan 5 or 10 mg at onset as regular or orally disintegrating tablet can repeat after 2 hours if needed Optimal dose is 10 mg maximum daily dose is 30 mg onset of effect is similar with standard and orally disintegrating tablets use 5-mg dose (15 ms day max) in patients receiving propranolol... 

Propranolol patients - In patients receiving propranolol, use the 5 mg dose of rizatriptan benzoate tablets, up to a maximum of 3 doses in 24 hours. 

PROPANOLOL 5-HT1 AGONISTS -RIZATRIPTAN Plasma levels of rizatriptan almost doubled during propranolol therapy Propanolol inhibits the metabolism of rizatriptan Initiate therapy with 5 mg rizatriptan and do not exceed 10 mg in 24 hours. The manufacturers recommend separating doses by 2 hours, although this has not been borne out by the studies... 

In four double-blind, placebo-controlled, randomized, crossover studies in 51 healthy subjects a single dose of rizatriptan 10 mg was administered after administration of propranolol 60 and 120 mg bd, nadolol 80 mg bd, metoprolol 100 mg bd, or placebo for 7 days (27). Propranolol 60 or 120 mg bd increased the AUC of rizatriptan by about 67% and the Cmax by about 75%. Nadolol and metoprolol had no effects. 

Goldberg MR, Sciberras D, De Smet M, Lowry R, Tomasko L, Lee Y, Olah TV, Zhao J, Vyas KP, Halpin R, Kari PH, James I. Influence of beta-adrenoceptor antagonists on the pharmacokinetics of rizatriptan, a 5-HTib id agonist differential effects of propranolol, nadolol and metoprolol. Br J Qin Pharmacol 2001 52(l) 69-76. 

No clinically important interaction occurs between most triptans and propranolol, but the plasma levels of rizatriptan are almost doubled by propranolol... 

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