Rizatriptan
| Evidence Level: L5 | Predicted Indications: 1 |
Table of Contents
Rizatriptan: Atrophoderma vermiculata
One-Sentence Summary
Rizatriptan is a triptan originally used to treat migraine, including migraine with or without aura. The TxGNN model predicts it may be effective for atrophoderma vermiculata, but there are currently no registered clinical trials and only general migraine literature (19 publications, none specific to brainstem aura) supporting this direction.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Not recorded in the local data |
| Predicted New Indication | Atrophoderma vermiculata |
| TxGNN Prediction Score | 0.9919 |
| Evidence Level | L5 |
| Canada Market Status | Marketed (marketed DINs on record: at least 19; dormant: 1) |
| Number of DINs | at least 20 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Currently, detailed mechanism of action data is not available in the data compiled for this report. Based on general knowledge, rizatriptan is a selective 5-HT1B/1D receptor agonist (a triptan) with proven efficacy in acute migraine, and it may be mechanistically applicable to related migraine subtypes.
Two caveats apply. First, the literature found covers general migraine, migraine with aura, menstrual, vestibular and pediatric migraine, but not brainstem aura specifically. Second, triptans have historically carried cautionary labelling in hemiplegic and basilar-type migraine because of a theoretical vasoconstrictive risk. Safety in this subtype needs explicit review before any recommendation.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
The publications below address migraine broadly. None studies brainstem aura directly.
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 25600718 | 2015 | Review | Headache | American Headache Society evidence assessment of acute migraine pharmacotherapies |
| 11687054 | 2001 | Review | Cochrane Database Syst Rev | Rizatriptan for acute migraine (benefit and harm assessment) |
| 25916333 | 2015 | Review | J Headache Pain | Meta-analysis comparing frovatriptan with rizatriptan and other triptans in migraine with aura |
| 24867845 | 2014 | RCT (pooled analysis) | Neurol Sci | Gender and triptan efficacy: pooled analysis of three crossover studies comparing frovatriptan with other triptans |
| 17718700 | 2007 | Study | Eur J Neurol | Triptans in familial or sporadic hemiplegic migraine: average response 6.9/10, and no patient had an ischaemic stroke or heart attack |
| 15209688 | 2004 | Placebo-controlled study | Headache | Early treatment of migraine with rizatriptan |
| 16336021 | 2005 | Review | PharmacoEconomics | Rizatriptan acts faster than sumatriptan 50 mg and naratriptan; pharmacoeconomic review |
| 22211870 | 2012 | Review | Headache | Rescue therapy for acute migraine with triptans, DHE and magnesium |
| 27910087 | 2017 | Review | Headache | Treatment options for menstrual migraine |
| 25538676 | 2014 | Review | Front Neurol | Treatment options in vestibular migraine |
Canada Market Information
Rizatriptan has 20 valid single-ingredient licences in Canada. The licence records compiled for this report do not include dosage form or approved indication text. The first five are listed below.
| DIN | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| 02393360 | PMS-RIZATRIPTAN RDT | Not available | Not available |
| 02396661 | TEVA-RIZATRIPTAN ODT | Not available | Not available |
| 02446111 | RIZATRIPTAN ODT | Not available | Not available |
| 02415801 | RIZATRIPTAN RDT | Not available | Not available |
| 02240519 | MAXALT RPD | Not available | Not available |
Safety Considerations
- Contraindications suggested by the knowledge graph (these come from disease-drug links, not label text): hypertension, liver disease, gallbladder disease, stroke and cerebrovascular disorders, cerebral infarction, myocardial infarction and coronary thrombosis, myocardial ischaemia, coronary artery disease, Prinzmetal angina, peripheral vascular disease and arterial disease, hemoglobinopathy, chronic kidney disease and end-stage renal failure, and familial or sporadic hemiplegic migraine.
- Drug Interactions: 80 interactions were identified. The Major ones include:
- Serotonergic and weight-loss agents: lorcaserin, fenfluramine, dexfenfluramine, sibutramine.
- 5-HT3 antagonists: ondansetron, granisetron, dolasetron, palonosetron.
Morphine, including the liposomal form, is rated Moderate.
- Several cardiovascular and cerebrovascular contraindications, plus hemiplegic migraine, overlap with the clinical profile of brainstem-aura migraine. This needs careful review.
Conclusion and Next Steps
Decision: Hold
Rationale: The mechanistic link to a closely related migraine subtype is plausible and the TxGNN score is very high. However, no trials or subtype-specific literature support this indication, so it remains a research question. Cautionary labelling and knowledge-graph contraindications around hemiplegic migraine and cerebrovascular disease add safety concerns that have not been resolved.
To proceed, the following is needed:
- Review of the Health Canada package insert warnings and contraindications, which is a blocking gap for safety screening
- Detailed mechanism of action data
- Subtype-specific evidence (case series, observational studies or trials) in migraine with brainstem aura
- Explicit safety assessment of triptan use in brainstem-aura and basilar-type migraine, including vascular risk screening
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.