Kommersiellt obunden läkemedelsinformation riktad till läkare och sjukvårdspersonal

Rizatriptan

Klassificering: A

Preparat: Maxalt, Maxalt Rapitab, Maxalt®, Maxalt® Rapitab®, Rizasmelt, Rizatriptan 2care4, Rizatriptan Actavis, Rizatriptan Aurobindo, Rizatriptan Glenmark, Rizatriptan Mylan, Rizatriptan Orifarm, Rizatriptan Sandoz, Rizatriptan STADA, Rizatriptan Teva

ATC kod: N02CC04

Substanser: rizatriptan, rizatriptanbensoat

Sammanfattning

Studier visar att effekten av rizatriptan vid akut migrän är likvärdig hos kvinnor och män.

Additional information

Rizatriptan is used to treat acute migraine attacks [1].Migraine is almost twice as common in women as in men [2, 3]. In a Swedish population- based study the one-year prevalence was 16.7 % in women and 9.5 % in men [4] which is slightly lower than three months prevalence reported from the US [2]. Another indication for (parenteral) triptans is cluster headache [5]. This is a trigeminal autonomic cephalgia with very painful, unilateral and short-lasting headache attacks. Cluster headache is rare with an estimated prevalence of 0.1%. In contrast to migraine, cluster headache is more common in men than in women [5]. The men-women ratio has recently been estimated to 2.5, older studies show a more pronounced male risk [6]. Smoking is a risk factor for cluster headache and the increased risk in women has been associated with more smoking in women [5, 6].

Pharmacokinetics and dosing

The pharmacokinetics of single oral doses of rizatriptan 2.5-15 mg administrated to healthy volunteers was studied in a randomized, crossover study (12 men, 12 women). The mean AUC of oral rizatriptan was 19-35% higher in women than in men. However, the difference is not likely to be of clinical relevance. Plasma clearance of rizatriptan was about 25% higher in men than in women. No difference in the dose-effect relationship between men and women was noted [7]. In another study (6 men, 6 women), where healthy volunteers received a single dose rizatriptan 10 mg, half-life was longer in men. Other pharmacokinetic parameters showed no sex differences [8, 9]. No pharmacokinetic differences between elderly men and women have been found [10].

Effects

The efficacy of rizatriptan 5 mg in adolescents (12-17 years old) was established in two randomized, placebo-controlled trials (212 men, 263 women). Rizatriptan 5 mg was shown to be more effective than standard care (patient’s usual migraine therapy) during long-term use (over 1 year). Treatment effects for pain relief were not dependent on patient’s sex [11].

Time to pain freedom in acute migraine with rizatriptan 10 mg was compared to standard care in a prospective, open-label study (197 men, 1292 women; mean age 41.7 years). There were no significant differences in time to pain freedom between men and women [12].

Results from randomized, double-blind studies of migraineurs (66 men, 280 women) show no sex differences in response to frovatriptan 2.5 mg, rizatriptan 10 mg, zolmitriptan 2.5 mg or almotriptan 12.5 mg [13].

Adverse effects

According to trials performed by the pharmaceutical company, incidence of adverse reactions did not differ between men and women [1].

Reproductive health issues

Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).

Försäljning på recept

Fler kvinnor än män hämtade ut läkemedel innehållande rizatriptan (ATC-kod N02CC04) på recept i Sverige år 2019, totalt 9 950 kvinnor och 2 112 män. Det motsvarar 2,0 respektive 0,4 personer per tusen invånare. Andelen som hämtat ut läkemedel var högst i åldersgruppen 45-59 år hos båda könen. I genomsnitt var läkemedel innehållande rizatriptan 4,7 gånger vanligare hos kvinnor [16].

Uppdaterat: 2020-09-07

Litteratursökningsdatum: 2020-01-17

Referenser

  1. Maxalt (rizatriptan). DailyMed [www]. US National Library of Medicine. [updated 2019-10-01, cited 2020-01-17]. länk
  2. Smitherman TA, Burch R, Sheikh H, Loder E. The prevalence, impact, and treatment of migraine and severe headaches in the United States: a review of statistics from national surveillance studies. Headache. 2013;53(3):427-36. PubMed
  3. Stovner LJ, Andree C. Prevalence of headache in Europe: a review for the Eurolight project. J Headache Pain. 2010;11(4):289-99. PubMed
  4. Dahlöf C, Linde M. One-year prevalence of migraine in Sweden: a population-based study in adults. Cephalalgia. 2001;21:664-71. PubMed
  5. Hoffmann J, May A. Diagnosis, pathophysiology, and management of cluster headache. Lancet Neurol. 2018;17(1):75-83. PubMed
  6. Russell MB. Epidemiology and genetics of cluster headache. Lancet Neurol. 2004;3(5):279-83. PubMed
  7. Lee Y, Conroy JA, Stepanavage ME, Mendel CM, Somers G, McLoughlin DA et al. Pharmacokinetics and tolerability of oral rizatriptan in healthy male and female volunteers. Br J Clin Pharmacol. 1999;47:373-8. PubMed
  8. Goldberg MR, Lowry RC, Musson DG, Birk KL, Fisher A, De Puy ME et al. Lack of pharmacokinetic and pharmacodynamic interaction between rizatriptan and paroxetine. J Clin Pharmacol. 1999;39:192-9. PubMed
  9. Dooley M, Faulds D. Rizatriptan: a review of its efficacy in the management of migraine. Drugs. 1999;58:699-723. PubMed
  10. Musson DG, Birk KL, Panebianco DL, Gagliano KD, Rogers JD, Goldberg MR. Pharmacokinetics of rizatriptan in healthy elderly subjects. Int J Clin Pharmacol Ther. 2001;39:447-52. PubMed
  11. Visser WH, Winner P, Strohmaier K, Klipfel M, Peng Y, McCarroll K et al. Rizatriptan 5 mg for the acute treatment of migraine in adolescents: results from a double-blind, single-attack study and two open-label, multiple-attack studies. Headache. 2004;44:891-9. PubMed
  12. Bell CF, Foley KA, Barlas S, Solomon G, Hu XH. Time to pain freedom and onset of pain relief with rizatriptan 10 mg and prescription usual-care oral medications in the acute treatment of migraine headaches: a multicenter, prospective, open-label, two-attack, crossover study. Clin Ther. 2006;28:872-80. PubMed
  13. Franconi F, Finocchi C, Allais G, Omboni S, Tullo V, Campesi I et al. Gender and triptan efficacy: a pooled analysis of three double-blind, randomized, crossover, multicenter, Italian studies comparing frovatriptan vs other triptans. Neurol Sci. 2014;35 Suppl 1:99-105. PubMed
  14. von Euler, M, Keshani, S, Baatz, K, Wettermark, B. PP261 - Utilization of triptanes in Sweden; analyses of over the counter and prescriptions sales. Clinical Therapeutics. 2013;8, Suppl(35):e99.
  15. Frisk P, Sporrong SK, Ljunggren G, Wettermark B, von Euler M. Utilisation of prescription and over-the-counter triptans: a cross-sectional study in Stockholm, Sweden. Eur J Clin Pharmacol. 2016;72(6):747-54. PubMed
  16. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2019 [cited 2020-03-10.] länk

Författare: Linnéa Karlsson Lind

Faktagranskat av: Mia von Euler, Diana Rydberg

Godkänt av: Karin Schenck-Gustafsson