Rizact MD Tablets (Rizatriptan benzoate )

Table of Content

For the use of Registered Medical Practitioner or Hospital or Laboratory Only

Qualitative and Quantitative Composition

RIZACT MD

Each orally disintegrating tablet contains

Rizatriptan benzoate IP equivalent to

Rizatriptan…………10 mg

Excipients………….qs

Dosage Form(S) and Strength(S)

Orally disintegrating tablet containing 10 mg of Rizatriptan benzoate.

Clinical Particulars

Therapeutic Indications

RIZACT MD indicated for acute treatment of headache phase of migraine with or without aura in adult only.

Posology and Method of Administration

Dosing Information in Adults

The recommended starting dose of rizatriptan benzoate is 10 mg for the acute treatment of migraines in adults. The 10-mg dose may provide a greater effect than the 5 mg dose but may have a greater risk of adverse reactions.

Redosing in Adults

Although the effectiveness of a second dose or subsequent doses has not been established in placebo-controlled trials, if the migraine headache returns, a second dose may be administered 2 hours after the first dose. The maximum daily dose should not exceed 30 mg in any 24-hour period. The safety of treating, on average, more than four headaches in a 30-day period has not been established.

Administration of RIZACT MD Orally Disintegrating Tablets

For RIZACT MD Orally Disintegrating Tablets, administration with liquid is not necessary. Orally disintegrating tablets are packaged in a blister within an outer aluminum pouch and patients should not remove the blister from the outer pouch until just prior to dosing. The blister pack should then be peeled open with dry hands and the orally disintegrating tablet placed on the tongue, where it will dissolve and be swallowed with the saliva.

Dosage Adjustment for Patients on Propranolol

Adult Patients

In adult patients taking propranolol, only the 5-mg dose of rizatriptan benzoate is recommended, up to a maximum of 3 doses in any 24-hour period (15 mg)

Contraindications

RIZACT MD is contraindicated in patients with:

  • Ischemic coronary artery disease (angina pectoris, history of myocardial infarction, or documented silent ischemia), or other significant underlying cardiovascular disease
  • Coronary artery vasospasm including Prinzmetal's angina
  • History of stroke or transient ischemic attack (TIA)
  • Peripheral vascular disease (PVD)
  • Ischemic bowel disease
  • Uncontrolled hypertension
  • Recent use (i.e., within 24 hours) of another 5-HT1 agonist, ergotamine-containing medication, or ergot-type medication (such as dihydroergotamine or methysergide)
  • Hemiplegic or basilar migraine
  • Concurrent administration or recent discontinuation (i.e., within 2 weeks) of a MAO-A inhibitor
  • Hypersensitivity to rizatriptan or any of the excipients (angioedema and anaphylaxis seen)

Special Warnings and Precautions for Use

Myocardial Ischemia, Myocardial Infarction, and Prinzmetal's Angina

Rizatriptan benzoate should not be given to patients with ischemic or vasospastic coronary artery disease. There have been rare reports of serious cardiac adverse reactions, including acute myocardial infarction, occurring within a few hours following administration of Rizatriptan benzoate. Some of these reactions occurred in patients without known coronary artery disease (CAD). 5-HT1 agonists, including Rizatriptan benzoate may cause coronary artery vasospasm (Prinzmetal's Angina), even in patients without a history of CAD.

Triptan-naïve patients who have multiple cardiovascular risk factors (e.g., increased age, diabetes, hypertension, smoking, obesity, strong family history of CAD) should have a cardiovascular evaluation prior to receiving Rizatriptan benzoate. If there is evidence of CAD or coronary artery vasospasm, Rizatriptan benzoate should not be administered. For patients who have a negative cardiovascular evaluation, consideration should be given to administration of the first Rizatriptan benzoate dose in a medically supervised setting and performing an electrocardiogram (ECG) immediately following Rizatriptan benzoate administration. Periodic cardiovascular evaluation should be considered in intermittent long-term users of Rizatriptan benzoate who have cardiovascular risk factors.

Arrhythmias

Life-threatening disturbances of cardiac rhythm, including ventricular tachycardia and ventricular fibrillation leading to death, have been reported within a few hours following the administration of 5-HT1 agonists. Discontinue Rizatriptan benzoate if these disturbances occur.

Chest, Throat, Neck and/or Jaw Pain/Tightness/Pressure

As with other 5-HT1 agonists, sensations of tightness, pain, pressure, and heaviness in the precordium, throat, neck and jaw commonly occur after treatment with Rizatriptan benzoate and are usually noncardiac in origin. However, if a cardiac origin is suspected, patients should be evaluated. Patients shown to have CAD and those with Prinzmetal's variant angina should not receive 5-HT1 agonists.

Cerebrovascular Events

Cerebral hemorrhage, subarachnoid hemorrhage, and stroke have occurred in patients treated with 5-HT1 agonists, and some have resulted in fatalities. In a number of cases, it appears possible that the cerebrovascular events were primary, the 5-HT1 agonist having been administered in the incorrect belief that the symptoms experienced were a consequence of migraine, when they were not. Also, patients with migraine may be at increased risk of certain cerebrovascular events (e.g., stroke, hemorrhage, transient ischemic attack). Discontinue Rizatriptan benzoate if a cerebrovascular event occurs.

As with other acute migraine therapies, before treating headaches in patients not previously diagnosed as migraineurs, and in migraineurs who present with atypical symptoms, care should be taken to exclude other potentially serious neurological conditions. Rizatriptan benzoate should not be administered to patients with a history of stroke or transient ischemic attack.

Other Vasospasm Reactions

5-HT1 agonists, including Rizatriptan benzoate, may cause non-coronary vasospastic reactions, such as peripheral vascular ischemia, gastrointestinal vascular ischemia and infarction (presenting with abdominal pain and bloody diarrhea), splenic infarction, and Raynaud’s syndrome. In patients who experience symptoms or signs suggestive of non-coronary vasospasm reaction following the use of any 5-HT1 agonist, the suspected vasospasm reaction should be ruled out before receiving additional Rizatriptan benzoate doses.

Reports of transient and permanent blindness and significant partial vision loss have been reported with the use of 5-HT1 agonists. Since visual disorders may be part of a migraine attack, a causal relationship between these events and the use of 5-HT1 agonists have not been clearly established.

Medication Overuse Headache

Overuse of acute migraine drugs (e.g., ergotamine, triptans, opioids, or a combination of drugs for 10 or more days per month) may lead to exacerbation of headache (medication overuse headache). Medication overuse headache may present as migraine-like daily headaches, or as a marked increase in frequency of migraine attacks. Detoxification of patients, including withdrawal of the overused drugs, and treatment of withdrawal symptoms (which often includes a transient worsening of headache) may be necessary.

Serotonin Syndrome

Serotonin syndrome may occur with triptans, including Rizatriptan benzoate particularly during co-administration with selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and MAO inhibitors. Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination) and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). The onset of symptoms can occur within minutes to hours of receiving a new or a greater dose of a serotonergic medication. Rizatriptan benzoate treatment should be discontinued if serotonin syndrome is suspected

Increase in Blood Pressure

Significant elevation in blood pressure, including hypertensive crisis with acute impairment of organ systems, has been reported on rare occasions in patients with and without a history of hypertension receiving 5-HT1 agonists, including Rizatriptan benzoate. In healthy young adult male and female patients who received maximal doses of Rizatriptan benzoate (10 mg every 2 hours for 3 doses), slight increases in blood pressure (approximately 2-3 mmHg) were observed. Rizatriptan benzoate is contraindicated in patients with uncontrolled hypertension

Drugs Interactions

Propranolol

The dose of Rizatriptan benzoate should be adjusted in propranolol-treated patients, as propranolol has been shown to increase the plasma AUC of rizatriptan by 70%.

In a study of concurrent administration of propranolol 240 mg/day and a single dose of rizatriptan 10 mg in healthy adult subjects (n=11), mean plasma AUC for rizatriptan was increased by 70% during propranolol administration, and a four-fold increase was observed in one subject. The AUC of the active N-monodesmethyl metabolite of rizatriptan was not affected by propranolol.

Nadolol/Metoprolol

In a drug interactions study, effects of multiple doses of nadolol 80 mg or metoprolol 100 mg every 12 hours on the pharmacokinetics of a single dose of 10 mg rizatriptan were evaluated in healthy subjects (n=12). No pharmacokinetic interactions were observed.

Ergot-Containing Drugs

Ergot-containing drugs have been reported to cause prolonged vasospastic reactions. Because these effects may be additive, use of ergotamine-containing or ergot-type medications (like dihydroergotamine or methysergide) and Rizatriptan benzoate within 24 hours is contraindicated

Other 5-HT1 Agonists

Because their vasospastic effects may be additive, co-administration of Rizatriptan benzoate and other 5-HT1 agonists within 24 hours of each other is contraindicated.

SSRIs/SNRIs and Serotonin Syndrome

Cases of serotonin syndrome have been reported during co-administration of triptans and selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs).

In a study of the interaction between the selective serotonin reuptake inhibitor (SSRI) paroxetine 20 mg/day for two weeks and a single dose of Rizatriptan benzoate 10 mg in healthy subjects (n=12), neither the plasma concentrations of rizatriptan nor its safety profile were affected by paroxetine.

Monoamine Oxidase Inhibitors

Rizatriptan benzoate is contraindicated in patients taking MAO-A inhibitors and non-selective MAO inhibitors. A specific MAO-A inhibitor increased the systemic exposure of rizatriptan and its metabolite.

Rizatriptan is principally metabolized via monoamine oxidase, ‘A’ subtype (MAO-A). Plasma concentrations of rizatriptan may be increased by drugs that are selective

MAO-A inhibitors (e.g., moclobemide) or nonselective MAO inhibitors (e.g., isocarboxazid, phenelzine, tranylcypromine, and pargyline). In a drug interaction study, when Rizatriptan benzoate 10 mg was administered to subjects (n=12) receiving concomitant therapy with the selective, reversible MAO-A inhibitor, moclobemide 150 mg t.i.d., there were mean increases in rizatriptan AUC and Cmax of 119% and 41% respectively; and the AUC of the active N-monodesmethyl metabolite of rizatriptan was increased more than 400%. The interaction would be expected to be greater with irreversible MAO inhibitors. No pharmacokinetic interaction is anticipated in patients receiving selective MAO-B inhibitors.

Oral contraceptives

In a study of concurrent administration of an oral contraceptive during 6 days of administration of Rizatriptan benzoate (10-30 mg/day) in healthy female volunteers (n=18), rizatriptan did not affect plasma concentrations of ethinyl estradiol or norethindrone.

Use in Special Population

Pregnant Women

Risk Summary

Available human data on the use of Rizatriptan benzoate in pregnant women are not sufficient to draw conclusions about drug-associated risk for major birth defects and miscarriage.

In animal studies, developmental toxicity was observed following oral administration of rizatriptan during pregnancy (decreased fetal body weight in rats) or throughout pregnancy and lactation (increased mortality, decreased body weight, and neurobehavioral impairment in rat offspring) at maternal plasma exposures greater than that expected at therapeutic doses in humans.

In the U.S. general population, the estimated background risk of major birth defects and of miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. The reported rate of major birth defects among deliveries to women with migraine range from 2.2% to 2.9% and the reported rate of miscarriage was 17%, which are similar to rates reported in women without migraine.

Clinical Considerations

Disease-Associated Maternal and/or Embryo/Fetal Risk

In women with migraine, there is an increased risk of adverse perinatal outcomes in the mother, including pre-eclampsia and gestational hypertension.

Data

Human Data

The Pregnancy Registry for Rizatriptan benzoate did not identify any pattern of congenital anomalies or other adverse birth outcomes over the period of 1998 to 2018. However, the lack of identification of any pattern should be viewed with caution, as the number of prospective reports with outcome information was low and did not provide sufficient power to detect an increased risk of individual birth defects associated with the use of Rizatriptan benzoate. Additionally, there was significant loss to follow-up in the prospective pregnancy reports, further complicating this assessment of an association between Rizatriptan benzoate and any pattern of congenital anomalies or other adverse birth outcomes.

In a study using data from the Swedish Medical Birth Register, live births to women who reported using triptans or ergots during pregnancy were compared with those of women who did not. Of the 157 births with first-trimester exposure to rizatriptan, 7 infants were born with malformations (relative risk 1.01 ). A study using linked data from the Medical Birth Registry of Norway to the Norwegian Prescription Database compared pregnancy outcomes in women who redeemed prescriptions for triptans during pregnancy, as well as a migraine disease comparison group who redeemed prescriptions for triptans before pregnancy only, compared with a population control group. Of the 310 women who redeemed prescriptions for rizatriptan during the first trimester, 10 had infants with major congenital malformations (OR 1.03 ), while for the 271 women who redeemed prescriptions for rizatriptan before, but not during, pregnancy, 12 had infants with major congenital malformations (OR 1.48 ), each compared with the population comparison group.

Animal Data

When rizatriptan (0, 2, 10, or 100 mg/kg/day) was administered orally to pregnant rats throughout organogenesis, a decrease in fetal body weight was observed at the highest doses tested. At the mid dose (10 mg/kg/day), which was a no-effect dose for adverse effects on embryofetal development, plasma exposure (AUC) was approximately 15 times that in humans at the maximum recommended human dose (MRHD) of 30 mg/day. When rizatriptan (0, 5, 10, or 50 mg/kg/day) was administered orally to pregnant rabbits throughout organogenesis, no adverse fetal effects were observed. Plasma exposure (AUC) at the highest dose tested was 115 times that in humans at the MRHD. Placental transfer of drug to the fetus was demonstrated in both species.

Oral administration of rizatriptan (0, 2, 10, or 100 mg/kg/day) to female rats prior to and during mating and continuing throughout gestation and lactation resulted in reduced body weight in offspring from birth and throughout lactation at all but the lowest dose tested (2 mg/kg/day). Plasma exposure (AUC) at the no-effect dose (2 mg/kg/day) for adverse effects on postnatal development was similar to that in humans at the MRHD.

Oral administration of rizatriptan (0, 5, 100, or 250 mg/kg/day) throughout organogenesis and lactation resulted in neonatal mortality, reduced body weight (which persisted into adulthood), and impaired neurobehavioral function in offspring at all but the lowest dose tested. Plasma exposure (AUC) at the no-effect dose for adverse effects on postnatal development (5 mg/kg/day) was approximately 8 times that in humans at the MRHD.

Lactating Women

Risk Summary

There are no data on the presence of rizatriptan or any active metabolites in human milk, or on the effects of rizatriptan on the breastfed infant, or on milk production.

Rizatriptan was excreted in rat milk, with levels in milk approximately 6 times those in maternal plasma.

The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for rizatriptan and any potential adverse effects on the breastfed infant from rizatriptan or from the underlying maternal condition.

Data

Following oral administration of rizatriptan to lactating rats at a dose of 100 mg/kg/day, drug concentrations of rizatriptan in milk samples exceeded maternal plasma drug concentrations by approximately 6-fold.

Paediatric Patients

Safety and effectiveness in pediatric patients under 6 years of age have not been established.

The efficacy and safety of Rizatriptan benzoate in the acute treatment of migraine in patients aged 6 to 17 years was established in an adequate and well-controlled study.

The incidence of adverse reactions reported for pediatric patients in the acute clinical trial was similar in patients who received Rizatriptan benzoate to those who received placebo. The adverse reaction pattern in pediatric patients is expected to be similar to that in adults.

Geriatric Patients

Clinical studies of Rizatriptan benzoate did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients.

Although the pharmacokinetics of rizatriptan were similar in elderly (aged 65 years) and in younger adults (n=17), in general, dose selection for an elderly patient should be cautious, starting at the low end of the dosing range. This reflects the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

Geriatric patients who have other cardiovascular risk factors (e.g., diabetes, hypertension, smoking, obesity, strong family history of coronary artery disease) should have a cardiovascular evaluation prior to receiving Rizatriptan benzoate

Patients with Phenylketonuria

Orally Disintegrating Tablets contain phenylalanine (a component of aspartame). The 10-mg orally disintegrating tablets contain 2.1 mg phenylalanine.

Effects on Ability to Drive and Use Machines

RIZACT MD may cause dizziness, weakness, or fainting. If you have these symptoms, do not drive a car, use machinery, or do anything that needs you to be alert.

Undesirable Effects

The following adverse reactions are discussed in more detail in other sections of the labeling:

  • Myocardial Ischemia, Myocardial Infarction, and Prinzmetal's Angina
  • Arrhythmias
  • Chest, Throat, Neck and/or Jaw Pain/Tightness/Pressure
  • Cerebrovascular Events
  • Other Vasospasm Reactions
  • Medication Overuse Headache
  • Serotonin Syndrome
  • Increase in Blood Pressure

Clinical Trials Experience

Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to rates in the clinical studies of another drug and may not reflect the rates observed in practice.

Adults

Incidence in Controlled Clinical Trials

Adverse reactions to Rizatriptan benzoate were assessed in controlled clinical trials that included over 3700 adult patients who received single or multiple doses of Rizatriptan benzoate Tablets. The most common adverse reactions during treatment with Rizatriptan benzoate (≥5% in either treatment group and greater than placebo) were asthenia/fatigue, somnolence, pain/pressure sensation and dizziness. These adverse reactions appeared to be dose related.

Table 1 lists the adverse reactions (incidence ≥2% and greater than placebo) after a single dose of Rizatriptan benzoate in adults.

Table 1: Incidence (≥2% and greater than placebo) of adverse reactions after a single dose of rizatriptan benzoate tablets or placebo in adults

Adverse Reactions

% of Patients

 

Rizatriptan benzoate

10 mg

(N=1167)

Placebo

(N=627)

 
 
 
 

Atypical Sensations

5

4

 

Paresthesia

4

<2

 

Pain and other Pressure Sensations

9

3

 

Chest Pain:

3

1

 

tightness/pressure and/or heaviness

 

Neck/throat/jaw:

2

1

 

pain/tightness/pressure

 

Regional Pain:

2

0

 

tightness/pressure and/or heaviness

 

Pain, location unspecified

3

<2

 

Digestive

13

8

 

3

1

 

Dry Mouth

 

6

4

 

Nausea

 
 

Neurological

20

11

 

Dizziness

9

5

 

Headache

2

<1

 

Somnolence

8

4

 

Other

7

2

 

Asthenia/fatigue

 

The frequencies of adverse reactions in clinical trials did not increase when up to three doses were taken within 24 hours. Adverse reaction frequencies were also unchanged by concomitant use of drugs commonly taken for migraine prophylaxis (including propranolol), oral contraceptives, or analgesics. The incidences of adverse reactions were not affected by age or gender. There were insufficient data to assess the impact of race on the incidence of adverse reactions.

Other Events Observed in Association with the Administration of Rizatriptan benzoate in Adults

In the following section, the frequencies of less commonly reported adverse events are presented that were not reported in other sections of the labeling. Because the reports include events observed in open studies, the role of Rizatriptan benzoate in their causation cannot be reliably determined. Furthermore, variability associated with adverse event reporting, the terminology used to describe adverse events, limit the value of the quantitative frequency estimates provided. Event frequencies are calculated as the number of patients who used Rizatriptan benzoate and reported an event divided by the total number of patients exposed to Rizatriptan benzoate (N=3716). All reported events occurred at an incidence ≥1%, or are believed to be reasonably associated with the use of the drug. Events are further classified within body system categories and enumerated in order of decreasing frequency using the following definitions: frequent adverse events are those defined as those occurring in at least (>)1/100 patients; infrequent adverse experiences are those occurring in 1/100 to 1/1000 patients; and rare adverse experiences are those occurring in fewer than 1/1000 patients.

General: Infrequent was facial edema. Rare were syncope and edema/swelling.

Atypical Sensations: Frequent were warm sensations.

Cardiovascular: Frequent was palpitation. Infrequent were tachycardia, cold extremities, and bradycardia.

Digestive: Frequent were diarrhea and vomiting. Infrequent were dyspepsia, tongue edema and abdominal distention.

Musculoskeletal: Infrequent were muscle weakness, stiffness, myalgia and muscle cramp/spasm.

Neurological/Psychiatric: Frequent were hypoesthesia, euphoria and tremor. Infrequent were vertigo, insomnia, confusion/disorientation, gait abnormality, memory impairment, and agitation.

Respiratory: Frequent was dyspnea. Infrequent was pharyngeal edema.

Special Senses: Infrequent were blurred vision and tinnitus. Rare was eye swelling.

Skin and Skin Appendage: Frequent was flushing. Infrequent were sweating, pruritus, rash, and urticaria. Rare was erythema, hot flashes.

Postmarketing Experience

The following section enumerates potentially important adverse events that have occurred in clinical practice and which have been reported spontaneously to various surveillance systems. The events enumerated include all except those already listed in other sections of the labeling or those too general to be informative. Because the reports cite events reported spontaneously from worldwide postmarketing experience, frequency of events and the role of Rizatriptan benzoate in their causation cannot be reliably determined.

Neurological/Psychiatric: Seizure.

General: Allergic conditions including anaphylaxis/anaphylactoid reaction, angioedema, wheezing, and toxic epidermal necrolysis.

Special Senses: Dysgeusia

Reporting of Suspected Adverse Reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. If your patient experiences any side-effects, write to drugsafety@cipla.com. You can also report side effects directly via the national pharmacovigilance program of India by calling on 1800 180 3024 or you can report to Cipla Ltd on 1800 267 7779. By reporting side-effects, you can help provide more information on the safety of this product.

Overdose

No overdoses of Rizatriptan benzoate were reported during clinical trials in adults.

Some adult patients who received 40 mg of Rizatriptan benzoate either a single dose or as two doses with a 2-hour interdose interval had dizziness and somnolence.

In a clinical pharmacology study in which 12 adult subjects received Rizatriptan benzoate, at total cumulative doses of 80 mg (given within four hours), two of the subjects experienced syncope, dizziness, bradycardia including third degree AV block, vomiting, and/or incontinence.

In the long-term, open label study, involving 606 treated pediatric migraineurs 12 to 17 years of age (of which 432 were treated for at least 12 months), 151 patients (25%) took two 10-mg doses of Rizatriptan benzoate Orally disintegrating tablet within a 24-hour period. Adverse reactions for 3 of these patients included abdominal discomfort, fatigue, and dyspnea.

In addition, based on the pharmacology of Rizatriptan benzoate, hypertension or myocardial ischemia could occur after overdosage. Gastrointestinal decontamination, (i.e., gastric lavage followed by activated charcoal) should be considered in patients suspected of an overdose with Rizatriptan benzoate. Clinical and electrocardiographic monitoring should be continued for at least 12 hours, even if clinical symptoms are not observed.

The effects of hemo or peritoneal dialysis on serum concentrations of rizatriptan are unknown.

Pharmacological Properties

Mechanism of Action

Rizatriptan binds with high affinity to human cloned 5-HT1B/1D receptors. Rizatriptan benzoate presumably exerts its therapeutic effects in the treatment of migraine headache by binding to 5-HT1B/1D receptors located on intracranial blood vessels and sensory nerves of the trigeminal system.

Pharmacokinetic Properties

Absorption

Rizatriptan is completely absorbed following oral administration. The mean oral absolute bioavailability of the Rizatriptan benzoate Tablet is about 45%, and mean peak plasma concentrations (Cmax) are reached in approximately 1-1.5 hours (Tmax). The presence of a migraine headache did not appear to affect the absorption or pharmacokinetics of rizatriptan. Food has no significant effect on the bioavailability of rizatriptan but delays the time to reach peak concentration by an hour. In clinical trials, Rizatriptan benzoate was administered without regard to food.

The bioavailability and Cmax of rizatriptan were similar following administration of rizatriptan benzoate Orally Disintegrating Tablets, but the rate of absorption is somewhat slower with rizatriptan benzoate, with Tmax delayed by up to 0.7 hour. AUC of rizatriptan is approximately 30% higher in females than in males. No accumulation occurred on multiple dosing.

Distribution

The mean volume of distribution is approximately 140 liters in male subjects and 110 liters in female subjects. Rizatriptan is minimally bound (14%) to plasma proteins.

Metabolism

The primary route of rizatriptan metabolism is via oxidative deamination by monoamine oxidase-A (MAO-A) to the indole acetic acid metabolite, which is not active at the 5-HT1B/1D receptor. N-monodesmethyl-rizatriptan, a metabolite with activity similar to that of parent compound at the 5-HT 1B/1D receptor, is formed to a minor degree. Plasma concentrations of N-monodesmethyl-rizatriptan are approximately 14% of those of parent compound, and it is eliminated at a similar rate. Other minor metabolites, the N-oxide, the 6-hydroxy compound, and the sulfate conjugate of the 6-hydroxy metabolite are not active at the 5-HT1B/1D receptor.

Elimination

The total radioactivity of the administered dose recovered over 120 hours in urine and feces was 82% and 12%, respectively, following a single 10-mg oral administration of 14C-rizatriptan. Following oral administration of 14C-rizatriptan, rizatriptan accounted for about 17% of circulating plasma radioactivity. Approximately 14% of an oral dose is excreted in urine as unchanged rizatriptan while 51% is excreted as indole acetic acid metabolite, indicating substantial first pass metabolism.

The plasma half-life of rizatriptan in males and females averages 2-3 hours.

Cytochrome P450 Isoforms

Rizatriptan is not an inhibitor of the activities of human liver cytochrome P450 isoforms 3A4/5, 1A2, 2C9, 2C19, or 2E1; rizatriptan is a competitive inhibitor (Ki=1400 nM) of cytochrome P450 2D6, but only at high, clinically irrelevant concentrations.

Special Populations

Geriatric: Rizatriptan pharmacokinetics in healthy elderly non-migraineur volunteers (age 65-77 years) were similar to those in younger non-migraineur volunteers (age 18-45 years).

Pediatric: The pharmacokinetics of rizatriptan was determined in pediatric migraineurs 6 to 17 years of age. Exposures following single dose administration of 5 mg Rizatriptan benzoate to pediatric patients weighing 20-39 kg (44-87 lb) or 10 mg Rizatriptan benzoate to pediatric patients weighing ≥40 kg (88 lb) were similar to those observed following single dose administration of 10 mg Rizatriptan benzoate orally disintegrating tablet to adults.

Gender: The mean AUC0-∞ and Cmax of rizatriptan (10 mg orally) were about 30% and 11% higher in females as compared to males, respectively, while Tmax occurred at approximately the same time.

Hepatic impairment: Following oral administration in patients with hepatic impairment caused by mild to moderate alcoholic cirrhosis of the liver, plasma concentrations of rizatriptan were similar in patients with mild hepatic insufficiency compared to a control group of subjects with normal hepatic function; plasma concentrations of rizatriptan were approximately 30% greater in patients with moderate hepatic insufficiency.

Renal impairment: In patients with renal impairment (creatinine clearance 10-60 mL/min/1.73 m2), the AUC0-∞ of rizatriptan was not significantly different from that in subjects with normal renal function. In hemodialysis patients, (creatinine clearance <2 mL/min/1.73 m2), however, the AUC for rizatriptan was approximately 44% greater than that in patients with normal renal function.

Race: Pharmacokinetic data revealed no significant differences between African American and Caucasian subjects.

Non-Clinical Properties

Carcinogenesis, Mutagenesis, Impairment of Fertility

Carcinogenesis

Oral carcinogenicity studies of rizatriptan were conducted in mice (100 weeks) and rats (106 weeks) at doses of up to 125 mg/kg/day. There was no evidence of an increase in tumor incidence related to rizatriptan in either species. Plasma exposures (AUC) at the highest dose tested were approximately 150 (mice) and 240 times (rats) that in humans at the maximum recommended human dose (MRHD) of 30 mg/day.

Mutagenesis

Rizatriptan was neither mutagenic nor clastogenic in a battery of in vitro and in vivo genetic toxicity studies, including: the microbial mutagenesis (Ames) assay, in vitro mammalian cell mutagenesis and chromosomal aberration assays, and the in vivo chromosomal aberration assay in mouse.

Impairment of Fertility

Oral administration of rizatriptan (0, 2, 10, or 100 mg/kg/day) to female rats prior to and during mating and continuing throughout gestation and lactation resulted in no effect on fertility; however, altered estrous cyclicity and delays in time to mating were observed at the highest dose tested. Plasma exposure at the no-effect dose (10 mg/kg/day) for reproductive toxicity was approximately 15 times that in humans at the MRHD.

Oral administration of rizatriptan (0, 5, 35, or 250 mg/kg/day) to male rats prior to and during mating resulted in no impairment of fertility or reproductive performance. Plasma exposure (AUC) at the highest dose tested was approximately 550 times that in humans at the MRHD.

Description

RIZACT MD contains rizatriptan benzoate, a selective 5-hydroxytryptamine1B/1D (5-HT1B/1D) receptor agonist.

Rizatriptan benzoate is described chemically as: N,N -dimethyl-5-(1H-1,2,4-triazol-1-ylmethyl)-1H-indole-3-ethanamine monobenzoate and its structural formula is:

Its empirical formula is C15H19N5•C7H6O2, representing a molecular weight of the free base of 269.4.

Pharmaceutical Particulars

Incompatibilities

Not Applicable

Shelf life

As on pack

Packaging Information

RiZACT MD 10 mg – Pack of 4 tablets

Storage and Handling Instruction

Store RIZACT MD at room temperature

Do not store above 30oC

Patient Counselling Information

What is RIZACT MD?

RIZACT MD is a prescription medicine that belongs to a class of medicines called Triptans. RIZACT MD is available as an orally disintegrating tablet

RIZACT MD used to treat migraine attacks with or without aura in adults and in children 6 to 17 years of age.

RIZACT MD is not to be used to prevent migraine attacks.

RIZACT MD is not for the treatment of hemiplegic or basilar migraines.

It is not known if RIZACT MD is safe and effective for the treatment of cluster headaches.

It is not known if taking more than 1 dose of RIZACT MD in 24 hours is safe and effective in children 6 to 17 years of age.

It is not known if RIZACT MD is safe and effective in children under 6 years of age.

Who should not take RIZACT MD?

Do not take RIZACT MD if you:

  • have or have had heart problems
  • have or have had a stroke or a transient ischemic attack (TIA)
  • have or have had blood vessel problems including ischemic bowel disease
  • have uncontrolled high blood pressure
  • have taken other Triptan medicines in the last 24 hours
  • have taken ergot-containing medicines in the last 24 hours
  • have hemiplegic or basilar migraines
  • take monoamine oxidase (MAO) inhibitor or have taken a MAO inhibitor within the last 2 weeks
  • are allergic to rizatriptan benzoate or any of the ingredients in RIZACT MD. See the end of this leaflet for a complete list of ingredients in RIZACT MD.

Talk to your doctor before taking this medicine if you have any of the conditions listed above or if you are not sure if you take any of these medicines.

What should I tell my doctor before taking RIZACT MD?

Before you take RIZACT MD, tell your doctor if you:

  • have or have had heart problems, high blood pressure, chest pain, or shortness of breath
  • have any risk factors for heart problems or blood vessel problems such as:
  • high blood pressure
  • high cholesterol
  • smoking
  • obesity
  • diabetes
  • family history of heart problems
  • you are post menopausal
  • you are a male over 40
  • have phenylketonuria (PKU). RIZACT MD orally disintegrating tablets contain phenylalanine.
  • have kidney or liver problems
  • have any other medical condition
  • are pregnant or plan to become pregnant. It is not known if RIZACT MD will harm your unborn baby. If you become pregnant while taking RIZACT MD, talk to your healthcare provider.
  • are breastfeeding or plan to breastfeed. It is not known if RIZACT MD passes into your breast milk. Talk to your doctor about the best way to feed your baby if you take RIZACT MD.

Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements.

RIZACT MD and other medicines may affect each other causing side effects. RIZACT MD may affect the way other medicines work, and other medicines may affect how RIZACT MD works.

Especially tell your doctor if you take:

  • propranolol containing medicines
  • medicines used to treat mood disorders, including selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs).

Ask your doctor or pharmacist for a list of these medicines, if you are not sure.

Know the medicines you take. Keep a list of them to show your doctor and pharmacist when you get a new medicine.

How should I take RIZACT MD?

  • Take RIZACT MD exactly as your doctor tells you to take it.
  • Your doctor will tell you how much RIZACT MD to take and when to take it.
  • To take RIZACT MD:
  • Leave RIZACT MD orally disintegrating tablets in the package it comes in until you are ready to take it. When you are ready to take it:
    • Remove the blister from the foil pouch. Do not push the RIZACT MD orally disintegrating tablet through the blister.
    • Peel open the blister pack with dry hands and place the RIZACT MD orally disintegrating tablet on your tongue. The tablet will dissolve and be swallowed with your saliva. No liquid is needed to take the orally disintegrating tablet.
  • If your headache comes back after your first RIZACT MD dose:
  • For adults: a second dose may be taken 2 hours after the first dose. Do not take more than 30 mg of RIZACT MD in a 24-hour period (for example, do not take more than 3 10-mg tablets in a 24-hour period).
  • If you take too much RIZACT MD, call your doctor or go to the nearest hospital emergency room right away.

What should I avoid while taking RIZACT MD?

RIZACT MD may cause dizziness, weakness, or fainting. If you have these symptoms, do not drive a car, use machinery, or do anything that needs you to be alert.

What are the possible side effects of RIZACT MD?

RIZACT MD may cause serious side effects. Call your doctor or go to the nearest hospital emergency room right away if you think you are having any of the serious side effects of RIZACT MD including:

  • heart attack. Symptoms of a heart attack may include:
  • chest discomfort in the center of your chest that lasts for more than a few minutes or that goes away and comes back
  • chest discomfort that feels like uncomfortable pressure, squeezing, fullness or pain o pain or discomfort in your arms, back, neck, jaw or stomach
  • shortness of breath with or without chest discomfort o breaking out in a cold sweat
  • nausea or vomiting o feeling lightheaded
  • stroke. Symptoms of a stroke may include the following sudden symptoms:
  • numbness or weakness in your face, arm or leg, especially on one side of your body o confusion, problems speaking or understanding
  • problems seeing in 1 or both of your eyes
  • problems walking, dizziness, loss of balance or coordination
  • severe headache with no known cause
  • blood vessel problems. Symptoms of blood vessel problems may include:
  • stomach pain
  • bloody diarrhea
  • vision problems
  • coldness and numbness of hands and feet
  • serotonin syndrome. A condition called serotonin syndrome can happen when Triptan medicines such as RIZACT MD are taken with certain other medicines. Symptoms of serotonin syndrome may include:
  • agitation
  • hallucinations o coma
  • fast heartbeat
  • fast changes in your blood pressure o increased body temperature
  • muscle spasm
  • loss of coordination
  • nausea, vomiting or diarrhea
  • Increased blood pressure.

The most common side effects of RIZACT MD in adults include:

  • feeling sleepy or tired
  • pain or pressure in your chest or throat
  • dizziness

Tell your doctor if you have any side effect that bothers you or that does not go away.

If you take RIZACT MD too often, this may result in you getting chronic headaches. In such cases, you should contact your doctor, as you may have to stop taking RIZACT MD.

These are not all the possible side effects of RIZACT MD. For more information, ask your doctor or pharmacist.

Reporting of Suspected Adverse Reactions

Reporting suspected adverse reactions after authorization of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. If your patient experiences any side-effects, write to drugsafety@cipla.com. You can also report side effects directly via the national pharmacovigilance program of India by calling on 1800 180 3024 or you can report to Cipla Ltd on 1800 267 7779. By reporting side-effects, you can help provide more information on the safety of this product.

How should I store RIZACT MD?

  • Store RIZACT MD at room temperature, do not store above 30°C.
  • Safely throw away medicine that is out of date or no longer needed.
  • Keep RIZACT MD and all medicines out of the reach of children.

General Information about the safe and effective use of RIZACT MD.

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use RIZACT MD for a condition for which it was not prescribed. Do not give RIZACT MD to other people, even if they have the same symptoms that you have. It may harm them.

What are the ingredients in RIZACT MD?

Active ingredient in RIZACT MD orally disintegrating tablets: rizatriptan benzoate.

Excipients in RIZACT MD orally disintegrating tablets: Calcium silicate, Microcrystalline Cellulose, Aspartame, Peppermint flavour, Mannitol, Aerosil, Sodium Steryl fumarate, Crospovidone

Details of Manufactures

CIPLA LTD

Cipla House, Peninsula Business Park,

Ganpatrao Kadam Marg,

Lower Parel, Mumbai - 400 013 INDIA

Details of Permission or Licence Number with Date

M/447/2007

Date of Revision

16/Feb/2021