Treating Migraines: Rizatriptan (Maxalt^®) vs. Sumatriptan (Imitrex^®)

Approximately 39 million Americans experience migraines and the debilitating pain that comes with them.¹ When a migraine strikes, acute medications can be a welcome relief. Two widely prescribed acute migraine medications include rizatriptan (Maxalt®) and sumatriptan (Imitrex®).

To help you make informed decisions about your migraine care, outlined here is detailed information on the mechanisms, effectiveness, side effects, and potential drug interactions of both rizatriptan and sumatriptan.

What is rizatriptan (Maxalt^®)?

Rizatriptan, a generic version of Maxalt®, is a medication used to treat acute migraines and headaches. It belongs to a class of medications called triptans.² Rizatriptan works by restricting blood vessels and blocking pain messages in the brain.³

Rizatriptan is used at the first sign of migraine symptoms and can start working in as little as 30 minutes. It can only treat a migraine that has already begun and will not prevent future migraines.⁴

Dosing, in oral tablet form, for an adult is 5mg to 10mg, once at a time. If symptoms have not improved two hours after the first dose, another dose can be taken. The maximum recommended dosage is 30mg within 24 hours.⁵

Rizatriptan has a relatively short half-life of just two to two and a half hours, which clears the system quickly. In a study of males, no accumulation of rizatriptan was found in the bloodstream after four consecutive days of use.⁶

What is sumatriptan (Imitrex^®)?

Sumatriptan, a generic version of Imitrex®, belongs to the class of medications known as selective serotonin receptor agonists. It works to treat migraines by narrowing blood vessels in the head, blocking pain signals in the brain, and inhibiting the release of natural substances that can cause nausea, pain, and other migraine symptoms. Sumatriptan is only used to treat migraines in the short term and will not prevent or reduce future migraines.⁷

Sumatriptan is available in three forms: oral tablet, injection, and nasal spray. The tablet will work around 10 to 20 minutes after ingestion, while injection and nasal spray are closer to 5 minutes for results. The peak effect occurs within two to four hours.⁸

Oral tablet dosages for sumatriptan include 25mg, 50mg, or 100mg, taken just once. If migraine symptoms persist or return after two hours, another dose can be taken. However, the max dosage recommended is 200mg in a 24-hour period.⁹

What’s the difference between rizatriptan and sumatriptan?

Rizatriptan and sumatriptan are similar medications that are used as acute treatments for migraine headaches. A main difference between the two medications is that rizatriptan is available exclusively via oral tablet, while sumatriptan is available in oral tablet, injection, and nasal spray forms.¹⁰

Both medications are relatively fast acting in oral form, but sumatriptan can offer relief in as little as five minutes with the injection or nasal spray forms.

How effective are rizatriptan and sumatriptan for treating migraines?

Rizatriptan and sumatriptan have both been clinically proven effective at quick relief for migraines. Approximately 60% to 70% of rizatriptan users will have significant pain relief within two hours of ingestion.¹¹ For sumatriptan users, 65% to 78% reported relief of migraine pain four hours post-dose. In the same study, oral sumatriptan also relieved nausea and photophobia (sensitivity to light) in participants.¹²

Can rizatriptan and sumatriptan be used together?

It is not recommended to use rizatriptan and sumatriptan together. Because they have similar effects, using these two medications together could cause excessive blood vessel narrowing, reducing blood flow to vital organs. In rare cases using rizatriptan and sumatriptan together could cause high blood pressure, heart attack, stroke, and gangrene (death of tissues).¹³

How often can rizatriptan and sumatriptan be taken?

Both rizatriptan and sumatriptan are designed for single, acute treatment of migraines. However, after the initial dose, the professional recommendation is that another dose can be taken two hours after the first if symptoms persist or return.

The maximum recommended dosage for rizatriptan is 30mg within 24 hours.¹⁴ For sumatriptan, the max dosage recommended is 200mg in a 24-hour period.¹⁵

How do the side effects compare for rizatriptan and sumatriptan?

Rizatriptan¹⁶ and sumatriptan¹⁷ share similar side effects including:

• Dizziness

• Nausea

• Flushing

• Drowsiness

• Muscle cramps

• Upset stomach, vomiting, diarrhea

Side effects exclusive to rizatriptan include dry mouth and tremors.¹⁸ Side effects exclusive to sumatriptan include tingling and weakness.¹⁹

What are common interactions for rizatriptan and sumatriptan?

There are no known food interactions with rizatriptan or sumatriptan. There are, however, quite a few possible drug interactions. Both medications have 69 major drug interactions that are known, so it is always important to disclose any medications you are currently taking to your medical provider before starting rizatriptan or sumatriptan.²⁰

Drug interactions to be mindful of include antidepressants like Cymbalta® (duloxetine), Lexapro® (escitalopram), Prozac® (fluoxetine), and Zoloft® (sertraline).²¹

Are rizatriptan and sumatriptan available over the counter?

Both rizatriptan and sumatriptan require a prescription and are not available over the counter.²²

Rizatriptan (Maxalt^®) vs Sumatriptan (Imitrex^®) Comparison Chart

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Get started on your migraine treatment journey with an online assessment.