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Sometimes patients have unusual personal circumstances that do not fit normal eligibility guidelines, which means that the applicant must file a formal appeal to get into the maxalt pap program.

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As with other 5-HT 1B/1D receptor agonistsrizatriptan should not be givenwithout prior evaluationto patients in whom unrecognised cardiac disease is likely or to patients at risk for coronary artery diseaseCADe.gpatients with hypertensiondiabeticssmokers or users of nicotine substitution therapymen over 40 years of agepost-menopausal womenpatients with bundle branch blockand those with strong family history for CADCardiac evaluations may not identify every patient who has cardiac disease andin very rare casesserious cardiac events have occurred in patients without underlying cardiovascular disease when 5-HT 1 agonists have been administeredThose in whom CAD is established should not be given MAXALTsee section 4.3

Angioedemae.gfacial oedematongue swelling and pharyngeal oedemamay occur in patients treated with triptansamong which is rizatriptanIf angioedema of the tongue or pharynx occursthe patient should be placed under medical supervision until symptoms have resolvedTreatment should promptly be discontinued and replaced by an agent belonging to another class of drugs.

The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotoninExamples include street drugs such as MDMAecstasyStJohn’s wortcertain antidepressantsincluding SSRIs such as fluoxetine/paroxetineSNRIs such as duloxetine/venlafaxineamong othersThe risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.

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