Maxalt and Maxalt-MLT Interactions: Alcohol, Medications, and Others

Maxalt and Maxalt-MLT (rizatriptan) are prescription drugs used to treat migraine. They can interact with other medications and some supplements. For example, Maxalt and Maxalt-MLT can interact with certain antidepressants and other migraine drugs.

Maxalt and Maxalt-MLT are used to treat migraine in adults.

An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.

Keep reading to learn about Maxalt and Maxalt-MLT’s possible interactions. And for more information about Maxalt and Maxalt-MLT, including details about their uses, see this article.

Certain health conditions or other factors could raise your risk of harm if you take Maxalt or Maxalt-MLT. In such cases, your doctor may not prescribe the drug for you. These are known as contraindications. The list below includes contraindications of Maxalt and Maxalt-MLT.

Taking Maxalt or Maxalt-MLT if you have any of the conditions described below may raise your risk of serious adverse events. Because of these risks, your doctor will likely avoid prescribing Maxalt or Maxalt-MLT for you. Instead, your doctor can discuss other migraine treatments that may be safer for you to take.

The problem isn’t a shortage of people wanting to be doctors, but rather, too few opportunities for training. Medical schools have increased class sizes by 30% since 2002, but federal funding for residency training – an essential step in the process of becoming a practicing physician – has not increased since 1997, according to Inside Higher Ed.

If you take or have recently taken certain other migraine drugs. You should not take Maxalt or Maxalt-MLT within 24 hours of taking:

a migraine drug that contains ergotamine, such as dihydroergotamine (Migranal)
another triptan medication (the group of drugs that Maxalt and Maxalt-MLT belong to) for migraine, such as sumatriptan (Imitrex)

You should not take these drugs within 24 hours of one another because both Maxalt and these migraine drugs can cause your blood vessels to narrow. Combining the two raises your risk of complications from blocked blood flow.

For examples of other migraine drugs that should not be used with Maxalt or Maxalt-MLT, see the “Does Maxalt or Maxalt-MLT interact with other drugs?” section below.

If you take or have recently taken a monoamine oxidase inhibitor (MAOI) drug. You should not take Maxalt or Maxalt-MLT if you’re also taking an MAOI drug. In addition, you should not take Maxalt or Maxalt-MLT for at least 14 days after your last dose of the MAOI.

This is because taking an MAOI drug with Maxalt or Maxalt-MLT causes very high levels of Maxalt in your body. This raises your risk of a serious condition called serotonin syndrome, which can be life threatening in some cases.

Symptoms of serotonin syndrome include tremors, hallucinations, fast heart rate, and muscle spasms. If you think you’re experiencing serotonin syndrome, call 911 or your local emergency number.

For examples of MAOI drugs, see the “Does Maxalt or Maxalt-MLT interact with other drugs?” section below.

If you have coronary artery disease or coronary artery spasms. In rare cases, Maxalt or Maxalt-MLT may cause serious heart problems, such as heart attack. If you have coronary artery disease or coronary artery spasms, your risk of these heart-related problems is higher.

If you’re at risk of heart disease, your doctor will likely run some tests to determine whether it’s safe for you to take Maxalt or Maxalt-MLT.

If you have high blood pressure that isn’t managed. In rare cases, Maxalt and Maxalt-MLT may cause heart-related problems, including heart attack. You have a higher risk of heart-related problems from taking Maxalt or Maxalt-MLT if you have high blood pressure that isn’t well managed. A severe increase in blood pressure called hypertensive crisis can also occur.

Your doctor will likely want to treat your high blood pressure first before they determine whether it’s safe for you to take Maxalt or Maxalt-MLT.

If you have peripheral vascular disease. In rare cases, Maxalt and Maxalt-MLT can cause problems with your blood flow and blood vessels, including narrowing your blood vessels. If you have peripheral vascular disease, taking Maxalt or Maxalt-MLT may worsen your condition. Because of this risk, taking Maxalt or Maxalt-MLT is not recommended if you have peripheral vascular disease.

If you’ve had a stroke or transient ischemic attack. In rare cases, Maxalt and Maxalt-MLT can cause bleeding in the brain or a stroke. Having migraine (which Maxalt and Maxalt-MLT are used to treat) also increases your risk of stroke or bleeding in your brain.

Because of this risk, using Maxalt or Maxalt-MLT if you’ve had a stroke or transient ischemic attack (also known as ministroke) is not recommended. Your doctor can talk with you about other treatment options.

If you have hemiplegic or basilar migraine. Having hemiplegic or basilar migraine raises your risk of bleeding in the brain or stroke. In rare cases, Maxalt and Maxalt-MLT can also cause bleeding in the brain or stroke. Due to this risk, Maxalt and Maxalt-MLT should not be used to treat hemiplegic or basilar migraine. Your doctor can tell you about other treatment options for these conditions.

Interaction with propranolol

Propranolol (Inderal LA and XL, InnoPran XL) interacts with Maxalt and Maxalt-MLT.

Propranolol is a beta-blocker that’s used to treat several heart-related conditions, such as high blood pressure and certain kinds of arrhythmia. It’s also sometimes used to prevent migraine headaches.

What could happen

Taking propranolol with Maxalt or Maxalt-MLT can raise your risk of side effects. This is because propranolol prevents your body from properly clearing Maxalt or Maxalt-MLT, which could cause levels of the drug to build up in your body.

What you can do

If you’re taking propranolol, your doctor will likely prescribe a lower dose of Maxalt or Maxalt-MLT for you. Specifically, it’s recommended that adults taking propranolol only use the 5-milligram (mg) dose of Maxalt or Maxalt-MLT. And you should not take more than three 5-mg doses of Maxalt or Maxalt-MLT over a 24-hour period if you’re also taking propranolol. Pediatric patients should only take one 5-mg dose of Maxalt or Maxalt-MLT in a 24-hour period.

Interaction with SSRIs and SNRIs

SSRIs and SNRIs are used to treat mental health conditions, including depression and anxiety.

It’s not unusual for people with migraine (the condition Maxalt and Maxalt-MLT are used to treat) to also have a mental health condition. In fact, some research has found that people with depression are twice as likely to be diagnosed with migraine.

Examples of SSRIs include:

sertraline (Zoloft)
fluoxetine (Prozac)
paroxetine (Paxil)
escitalopram (Lexapro)
citalopram (Celexa)

And examples of SNRIs include:

duloxetine (Cymbalta)
venlafaxine (Effexor XR)
desvenlafaxine (Pristiq)

What could happen

Taking Maxalt or Maxalt-MLT with an SSRI or SNRI increases your risk of serotonin syndrome. This is a rare side of Maxalt and Maxalt-MLT and of SSRIs and SNRIs.

What you can do

Before you begin treatment with Maxalt or Maxalt-MLT, tell your doctor if you’re taking an SSRI or SNRI drug. Whether your doctor prescribes Maxalt for you will depend on whether the risks outweigh the benefits. For example, if you’re already taking more than one drug that can cause serotonin syndrome, your doctor may not prescribe Maxalt or Maxalt-MLT.

Call your doctor right away if you think you’re having symptoms of serotonin syndrome while using Maxalt or Maxalt-MLT, especially if you’re also taking an SSRI or SNRI drug. If your symptoms feel life threatening, go to the closest emergency room or call 911 or your local emergency number.

If your doctor confirms you’ve developed serotonin syndrome while using Maxalt or Maxalt-MLT, they’ll likely stop your treatment. They can recommend other treatment options for migraine.

Maxalt and Maxalt-MLT may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Maxalt and Maxalt-MLT.

Does Maxalt or Maxalt-MLT interact with supplements?

Before you start taking Maxalt and Maxalt-MLT, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take. Sharing this information with them may help you avoid possible interactions.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Maxalt or Maxalt-MLT and herbs

There are currently no reports of Maxalt and Maxalt-MLT interacting with herbs. But this doesn’t mean that interactions with herbs won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Maxalt or Maxalt-MLT.

Maxalt or Maxalt-MLT and vitamins

There are currently no reports of Maxalt or Maxalt-MLT interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while using Maxalt or Maxalt-MLT.

Does Maxalt or Maxalt-MLT interact with food?

There are currently no reports of Maxalt and Maxalt-MLT interacting with food. If you have questions about eating certain foods during your treatment with either of these drugs, talk with your doctor.

Does Maxalt or Maxalt-MLT interact with vaccines?

There are currently no reports of Maxalt or Maxalt-MLT interacting with vaccines. If you have questions about receiving vaccines during your treatment with either of these drugs, talk with your doctor.

Does Maxalt or Maxalt-MLT interact with lab tests?

There are currently no reports of Maxalt or Maxalt-MLT interacting with lab tests. If you have questions about getting any lab tests during your treatment, talk with your doctor.

Does Maxalt or Maxalt-MLT interact with cannabis or CBD?

There are currently no reports of Maxalt and Maxalt-MLT interacting with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). But as with any drug or supplement, talk with your doctor before using cannabis with Maxalt and Maxalt-MLT.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions or other health factors may raise the risk of interactions with Maxalt or Maxalt-MLT. Before taking either of these drugs, talk with your doctor about your health history. They’ll determine whether the drug is right for you.

When you should not use Maxalt or Maxalt-MLT

Doctors will usually avoid prescribing Maxalt or Maxalt-MLT if you have any of the following conditions. See the “When should I avoid Maxalt and Maxalt-MLT?” section above for more information.

if you take or have recently taken certain other migraine drugs
if you take or have recently taken a monoamine oxidase inhibitor (MAOI) drug
if you have coronary artery disease or coronary artery spasms
if you have high blood pressure that isn’t well managed
if you have peripheral vascular disease
if you’ve had a stroke or transient ischemic attack (also known as a ministroke)
if you have hemiplegic or basilar migraine
if you have ischemic bowel disease
if you’ve had an allergic reaction to Maxalt or Maxalt-MLT

Other health condition interactions with Maxalt or Maxalt-MLT

Certain health conditions or other factors that might interact with Maxalt or Maxalt-MLT include:

A problem with your heart’s electrical signal, such as Wolff-Parkinson-White (WPW) syndrome. In rare cases, Maxalt or Maxalt-MLT can cause heart-related issues. These can include life threatening problems with your heart rhythm. Your risk of heart-related problems from taking Maxalt or Maxalt-MLT is higher if you already have a condition that affects your heart’s electrical signal, including WPW syndrome.

How long does Maxalt stay in your system?

After you take a dose, Maxalt or Maxalt-MLT stays in your system for about 10 to 15 hours. Because of this, you should not take Maxalt or Maxalt-MLT within 24 hours of using:

a migraine drug that contains ergotamine, such as dihydroergotamine (Migranal)
another triptan medication (the group of drugs that Maxalt and Maxalt-MLT belong to) for migraine, such as sumatriptan (Imitrex)

Waiting to take Maxalt or Maxalt-MLT 24 hours after these other drugs gives your body enough time to clear the other drug from your system. This helps you avoid the effects of a drug interaction.

Is it safe to take Maxalt or Maxalt-MLT with Tylenol (acetaminophen)?

Yes, if your doctor says so. Maxalt and Maxalt-MLT aren’t known to interact with acetaminophen (Tylenol).

Acetaminophen can be useful for treating migraine in some people. You may also want to take a dose to treat other aches or pains besides migraine.

Even though acetaminophen can be bought over the counter, it’s still important to talk with your doctor or pharmacist before taking it with Maxalt or Maxalt-MLT.

Can I take an NSAID such as ibuprofen if I’m also taking Maxalt or Maxalt-MLT?

Yes, if you doctor says it’s safe. There’s no known interaction between Maxalt or Maxalt-MLT and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.

NSAIDs may be taken to treat other aches or pains besides migraine. If you’d like to take ibuprofen or another NSAID with Maxalt or Maxalt-MLT, ask your doctor or pharmacist if it’s safe to do so.

Taking certain steps can help you avoid interactions with Maxalt and Maxalt-MLT. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:

Whether you drink alcohol or use cannabis.
Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a medication list .
What to do if you start taking a new drug during your Maxalt or Maxalt-MLT treatment.

It’s also important to understand Maxalt and Maxalt-MLT’s label and other paperwork that may come with the drug. Colored stickers that describe interactions may be on the label. And the paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions. (If you did not get paperwork with Maxalt and Maxalt-MLT, ask your pharmacist to print a copy for you.)

If you have trouble reading or understanding this information, your doctor or pharmacist can help.

Taking Maxalt or Maxalt-MLT exactly as prescribed can also help prevent interactions.

If you still have questions about Maxalt or Maxalt-MLT and their possible interactions, talk with your doctor.

Questions you may want to ask your doctor include:

How do interactions of Maxalt or Maxalt-MLT compare with those of other migraine drugs?
If I need to take a dose of Maxalt or Maxalt-MLT, do I need to space out the doses of other medications I take?
Does my dosage of Maxalt or Maxalt-MLT affect my risk of interactions?

To learn more about Maxalt and Maxalt-MLT, see these articles:

Side Effects of Maxalt and Maxalt-MLT: What You Need to Know
Dosage Details for Maxalt and Maxalt-MLT

To get information on different conditions and tips for improving your health, subscribe to any of Austra Health’s newsletters. You may also want to check out the online communities at Bezzy. It’s a place where people with certain conditions can find support and connect with others.

Disclaimer: Austra Health has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Last medically reviewed on March 22, 2023

Drug group or drug name	Drug examples	What can happen
other triptan drugs	• sumatriptan (Imitrex) • almotriptan (Axert) • zolmitriptan (Zomig)	can increase the risk of side effects from Maxalt or Maxalt-MLT and other triptan drugs
migraine drugs that contain ergot or ergotamines	• dihydroergotamine (Migranal, Trudhesa) • ergotamine (Ergomar)	can raise the risk of side effects from Maxalt or Maxalt-MLT and other migraine drugs
monoamine oxidase inhibitors (MAOIs)	• tranylcypromine (Parnate) • phenelzine (Nardil) • isocarboxazid (Marplan)	can increase the risk of side effects from Maxalt or Maxalt-MLT
selective serotonin reuptake inhibitors (SSRIs)	• sertraline (Zoloft) • fluoxetine (Prozac) • paroxetine (Paxil)	can raise the risk of side effects from Maxalt or Maxalt-MLT and SSRIs
serotonin-norepinephrine reuptake inhibitors (SNRIs)	• duloxetine (Cymbalta) • venlafaxine (Effexor XR)	can increase the risk of side effects from Maxalt and Maxalt-MLT and SNRIs
tricyclic antidepressants (TCAs)	• amitriptyline • nortriptyline (Pamelor)	can increase the risk of side effects from Maxalt or Maxalt-MLT and TCAs
propranolol (Inderal LA and XL, InnoPran XL)	—	can raise the risk of side effects from Maxalt or Maxalt-MLT