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Maxalt acts as an agonist to 5-HT1B and 5-HT1D receptors on extracerebral and intracranial blood vessels. Migraine head ache is due to local cranial vasodilatation and/or to the release of vasoactive and pro-inflammatory peptides from sensory nerve endings in an activated trigeminal system. In migraine attack intracranal blood vessels become dilated. Maxalt activates 5-HT1B and 5-HT1D receptors and cause cranial vessel constriction, inhibition of neuropeptide release and reduced transmission in trigeminal pain pathways.

The common side effects reported with Maxalt are warm/cold sensations, palpitation, diarrhea, vomiting, hypesthesia, mental acuity decreased, euphoria, tremor, dyspnea, flushing and hot flashes.

The use of ergotamine-containing or ergot-type medications (like dihydroergotamine or methysergide) and Maxalt are contraindicated within a day. The concomitant use of selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) and Maxalt can cause fatal serotonin syndrome. Maxalt should not be used along with monoamine oxidase inhibitors. Rizatriptan should be given only after 2 weeks of discontinuing MAO inhibitors. Maxalt should be used with caution in patients with diseases that alter pharmacokinetics of drugs. Rizatriptan should be used with caution in patients with renal or hepatic impairment. The patient should be advised to avoid complex tasks as Rizatriptan can cause somnolence and dizziness. Rizatriptan is not recommended in pregnancy and in nursing mothers. Maxalt is not recommended in patients below the age of 18. Maxalt should not be given to patients with ischemic heart disease or patients with uncontolled hypertension.

The recommended starting dose of Maxalt is 5 or 10mg for the acute treatment of migraines in adults. The doses of Rizatriptan should be separated by at least 2 hours. The maximum dose of Maxalt is  30 mg /day.