Rizatriptan
| Evidence Level: L5 | Predicted Indications: 1 |
Table of Contents
Rizatriptan: Atrophoderma vermiculata
One-Sentence Summary
Rizatriptan is a triptan originally used to treat acute migraine. but no clinical trials are registered for this specific subtype, and the 19 publications retrieved cover migraine broadly and are indirect evidence only.
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 |
| India Market Status | Listed in a compiled Indian medicine price dataset (at least 20) – CDSCO approval status is not included in this data |
| Number of Listed Products | 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 known information, rizatriptan is a triptan (a selective 5-HT1B/1D receptor agonist) used for acute migraine with or without aura, and its efficacy in migraine is well established.
Migraine with brainstem aura is a subtype of migraine with aura. The two share core pathophysiology: activation of the trigeminovascular system, CGRP release and cranial vasodilation. This makes the prediction biologically plausible, and the very high TxGNN score reflects how close the new indication sits to the approved migraine indications.
There is an important caveat. None of the retrieved studies evaluates brainstem aura specifically. Triptans have historically been used cautiously or avoided in this subtype (formerly called basilar-type migraine) because of theoretical vascular concerns. The evidence is therefore indirect, and a safety evaluation is needed before any recommendation.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
The literature below is drawn from the broader migraine population. Reviews and RCT-type analyses are prioritised.
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 25600718 | 2015 | Review | Headache | American Headache Society evidence assessment of acute migraine pharmacotherapies in adults |
| 11687054 | 2001 | Review | Cochrane Database Syst Rev | Cochrane review of rizatriptan for acute migraine |
| 25916333 | 2015 | Review (meta-analysis) | J Headache Pain | Frovatriptan compared with rizatriptan, zolmitriptan and almotriptan in migraine with aura |
| 24867845 | 2014 | RCT (pooled analysis) | Neurol Sci | Gender and triptan efficacy: frovatriptan vs. other triptans in three crossover studies |
| 17718700 | 2007 | Observational study | Eur J Neurol | Triptans in familial or sporadic hemiplegic migraine: average response 6.9/10, and no ischaemic stroke or heart attack among 76 users |
| 16336021 | 2005 | Review | PharmacoEconomics | Rizatriptan 10 mg gave faster pain relief than sumatriptan 50 mg, with similar tolerability |
| 22211870 | 2012 | Review | Headache | Rescue therapy with triptans, DHE and magnesium in emergency and clinic settings |
| 15209688 | 2004 | Placebo-controlled study | Headache | Efficacy of rizatriptan given early in a migraine attack |
| 23695053 | 2013 | Review of randomized studies | Neurol Sci | Efficacy of frovatriptan and other triptans, including rizatriptan, in hypertensive vs. normotensive migraineurs |
| 32952420 | 2020 | Clinical study | Noro Psikiyatr Ars | Cerebral haemodynamic changes during migraine attacks and after frovatriptan and rizatriptan |
India Market Information
Showing 5 of 20 valid registrations. All are single-ingredient products. The approved indication text was not available in the registration data.
| Authorization Number | Product Name | Dosage Form | Manufacturer |
|---|---|---|---|
| 141907 | Migsun 5mg Tablet | Strip of 4 tablets | Sunrise Remedies Pvt Ltd |
| 186973 | Ritza 5mg Tablet | Strip of 6 tablets | Natco Pharma Ltd |
| 184687 | Rizora 10 Tablet | Strip of 4 tablets | Intas Pharmaceuticals Ltd |
| 188477 | Rizamelt 5 Disintegrating Strip | Packet of 5 disintegrating strips | Arinna Lifescience Pvt Ltd |
| 184240 | Rizact 10 Tablet | Strip of 4 tablets | Cipla Ltd |
Safety Considerations
- Contraindications suggested by the knowledge graph (not taken from label text): hypertension, liver disease, gallbladder disease, stroke and cerebrovascular disorders, cerebral infarction, myocardial infarction, coronary artery disease, myocardial ischaemia, Prinzmetal angina, peripheral vascular disease and peripheral arterial disease, chronic kidney disease and end-stage renal failure, hemoglobinopathy, and familial or sporadic hemiplegic migraine.
- Drug Interactions: 80 interactions were identified. Those rated Major are lorcaserin, dolasetron, palonosetron, ondansetron, granisetron, dexfenfluramine, fenfluramine and sibutramine, mostly serotonergic agents. Morphine (including liposomal) is rated Moderate. The remaining interactions listed (for example pantoprazole, omeprazole, metformin and prednisone) have no severity rating.
- Subtype-specific concern: triptans have historically been used cautiously or avoided in brainstem aura because of theoretical vascular risk. The vascular contraindications above reinforce the need for a dedicated safety review.
Please also refer to the package insert, as label warnings and contraindications were not available in the data compiled for this report.
Conclusion and Next Steps
Decision: Hold
Rationale: The prediction is biologically plausible and rizatriptan is widely marketed in India. However, there are no trials specific to brainstem aura, the supporting literature is indirect, and the theoretical vascular safety concern for this subtype is unresolved. This corresponds to an L3 evidence level and a research question rather than an actionable repurposing candidate.
To proceed, the following is needed:
- The India package insert warnings and contraindications (a blocking gap for safety screening)
- Mechanism of action data from DrugBank
- A targeted literature review or case series on triptan use and outcomes in brainstem aura
- A dedicated vascular safety assessment for this subtype
- Approved indication text for the India registrations, to confirm the labelled scope
Note on the second predicted indication: atrophoderma vermiculata (TxGNN score 0.9919) has no clinical or literature support and no clear mechanistic link to 5-HT1B/1D agonism. It is likely a TxGNN model (deep learning) artefact, is rated L5, and the recommendation is Hold.
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.