Tried migraine treatment before? You've probably come across two names again and again: sumatriptan and rizatriptan.
Both belong to a group of medicines called triptans. Both treat migraine attacks rather than preventing them, and both are available in the UK.
But they're not identical. They differ in how quickly they work, what forms they come in and how they interact with other medicines.
This guide compares sumatriptan and rizatriptan on the things that matter most when choosing between them: how fast they work, dosage, side effects, formats, and when one might suit you better than the other.
Same job, different strengths. The best triptan for you often comes down to how fast your migraines build and what else you take.
What are sumatriptan and rizatriptan?
Sumatriptan was the first triptan, introduced in 1991.1 It's sold under the brand name Imigran, as well as in generic versions.
Pharmacy packs of sumatriptan 50mg tablets can be bought without a prescription. They're for adults aged 18 to 65 who've already been diagnosed with migraine by a doctor or pharmacist.2 The 100mg tablets and other formats need a prescription.
Rizatriptan came later. It comes as standard tablets and as orodispersible tablets (sometimes called wafers or melts), which dissolve on your tongue without water. It's sold as Maxalt and Maxalt Melt.
Unlike sumatriptan, rizatriptan is prescription-only in every dose and format.
Both are licensed to treat migraine attacks, with or without aura, in adults. Neither is used to prevent migraine. You take them once a headache has started, not as a daily preventive.3,4
How do they work?
Sumatriptan and rizatriptan are both selective 5-HT1B/1D receptor agonists. That label describes exactly what they do.
Serotonin (5-HT) receptors are found on the blood vessels around your brain, and on the trigeminal nerve, which plays a central role in migraine pain.
During a migraine attack, these blood vessels are thought to widen. The trigeminal nerve endings around them also release substances that cause inflammation and pass on pain signals.
Both medicines act on these receptors to narrow the widened blood vessels. They also reduce the release of those pain-signalling substances from the nerve endings. The result is relief from headache pain and other migraine symptoms.4,5
The way they work is the same. The practical differences come from how much of each dose your body absorbs, how quickly, and what forms they come in.
Sumatriptan vs rizatriptan: key differences at a glance
|
Sumatriptan |
Rizatriptan |
| Licensed dose (oral) |
50mg to 100mg |
10mg (5mg for some people, such as those taking propranolol) |
| Bioavailability (oral) |
Around 14% |
Around 40 to 45% |
| Orodispersible formulation |
No (UK) |
Yes (wafer/melt) |
| Nasal spray |
Yes (10mg, 20mg) |
No |
| Subcutaneous injection |
Yes (6mg) |
No |
| OTC availability |
Yes (50mg tablets, ages 18 to 65) |
No (prescription-only) |
| Max dose per 24 hours |
300mg (prescription tablets) |
20mg (10mg if you're on the 5mg dose) |
| Caution with propranolol |
No dose adjustment needed |
5mg dose, at least 2 hours apart |
| Kidney or liver problems |
Ask your prescriber |
5mg if mild to moderate; not suitable if severe |
The 300mg limit applies to prescription sumatriptan tablets only. Pharmacy packs have a lower limit of two 50mg tablets in 24 hours.2 Always follow the leaflet that comes with your medicine.
How quickly does each work?
For most people, how fast each one works is the most meaningful difference.
Rizatriptan is absorbed quickly and completely. Its level in your blood peaks around one to one and a half hours after a tablet. Around 40 to 45% of each dose reaches your circulation.4
In clinical trials, headache relief started as early as 30 minutes after a dose of rizatriptan.4
Sumatriptan is also absorbed quickly, but less completely. Only around 14% of a tablet dose reaches your circulation, partly because a lot of it is broken down before it gets there.5
Relief usually begins around 30 minutes after a 100mg tablet.5
Four randomised trials have compared the two tablets head to head. In two of them, rizatriptan 10mg started working faster than sumatriptan 50mg. Rizatriptan 10mg also left more people pain-free at two hours than sumatriptan 100mg, with fewer side effects.1
Do your migraines build quickly or get severe fast? Rizatriptan's speed may be the deciding factor. If your attacks build more gradually, the difference may matter less.
Dosage and how to take each medicine
Sumatriptan dosage
The usual starting dose of sumatriptan tablets is 50mg, taken as early as possible once the migraine starts. Some people need 100mg.5
If the headache comes back after it first eases, you can take a second dose, as long as at least two hours have passed since the first. The maximum for prescription tablets in any 24 hours is 300mg.5 With pharmacy packs, the limit is two 50mg tablets in 24 hours.2
If a dose doesn't help at all, do not take a second dose for the same attack. Use a non-triptan painkiller, like paracetamol or ibuprofen, instead. You can still use sumatriptan for your next attack.3
Rizatriptan dosage
The standard dose of rizatriptan is 10mg. As with sumatriptan, take it once the headache starts. If the headache comes back after it first eases, you can take one more dose, with at least two hours between doses. No more than two doses should be taken in 24 hours, so the maximum is 20mg.4
Some people need the lower 5mg dose instead:4
- If you take propranolol - a beta-blocker often used to prevent migraine. Propranolol raises rizatriptan levels in your blood, because an enzyme called MAO-A breaks down both. Take the two at least two hours apart.
- If you have mild to moderate kidney or liver problems - your prescriber will usually start you on the lower dose.
Rizatriptan is not suitable if you have severe kidney or liver problems.4 Your prescriber will choose the right dose for you. Do not change your dose yourself.
Food can delay how quickly rizatriptan is absorbed by about an hour, so it may start working sooner on an empty stomach.4
Do not take a second triptan dose if the first did not help at all. Switch to paracetamol or ibuprofen for that attack instead.
Formulations: tablets, sprays, and melts
Sumatriptan has the wider range of formats in the UK:
- Tablets (50mg, 100mg) - the most commonly used form
- Nasal spray (10mg, 20mg) - useful if nausea stops you swallowing tablets
- Injection under the skin (6mg) - generally kept for severe or fast-peaking attacks
Rizatriptan comes as:
- Standard tablets (5mg, 10mg) - swallowed with water
- Orodispersible tablets (wafers or melts) - these dissolve on your tongue without water, which helps if nausea makes swallowing difficult or you're caught without a drink
The melts aren't faster than the standard tablet. In fact, their peak level comes 30 to 60 minutes later than the tablet's.6 Their advantage is convenience: they're easy to take the moment an attack starts, with no drink needed.
Melts aren't faster than tablets, just easier. They're handy when nausea or no water would otherwise delay your dose.
Side effects
Sumatriptan and rizatriptan have broadly similar side effects, as you'd expect from medicines that work the same way. Common side effects (affecting up to 1 in 10 people) with both include:3,4
- Tingling, warmth, heaviness or pressure, especially in the face, limbs or chest
- Flushing
- Dizziness or drowsiness
- Nausea
- Tiredness or weakness
Dry mouth is also a common side effect of rizatriptan.4 Both can make you drowsy, so take care with driving or using machinery until you know how you react.3
A brief feeling of tightness or pressure in the chest or throat is a recognised effect of both triptans, and it can be alarming. It usually passes quickly, but it can be hard to tell apart from a heart symptom.3
If chest pain is severe, does not pass within a few minutes, or comes with other symptoms like pain spreading to your arm or jaw, stop taking the medicine and call 999.
One review comparing migraine treatments found side effects were more common with sumatriptan than with almotriptan, another triptan.7 But everyone responds differently, and how well you tolerate a triptan is partly personal. If side effects bother you, speak to your prescriber or pharmacist.
Medication overuse headache is a risk with any treatment for migraine attacks, including both triptans. NICE says to be alert to it if someone has taken triptans on 10 or more days a month, or paracetamol or NSAIDs on 15 or more days a month, for 3 months or more.8 Either pattern can cause a cycle of rebound headaches that becomes harder to treat. If you find yourself using triptans often, speak to your GP about preventive options.
Chest tightness after a triptan usually settles quickly. If it's severe or will not pass, treat it as an emergency and get help.
Drug interactions
Both medicines: ergotamine and other triptans
Do not take sumatriptan or rizatriptan with ergotamine-containing medicines or other triptans. Combining them raises the risk of the blood vessels around your heart narrowing.
Wait at least 24 hours after taking an ergotamine medicine before taking either triptan. After taking either triptan, wait at least six hours before taking any ergotamine-type medicine.4,5
Both medicines: MAOIs
Do not take sumatriptan or rizatriptan if you take monoamine oxidase inhibitors (MAOIs), a type of antidepressant. The same applies for two weeks after stopping an MAOI.3,4
Both medicines: SSRI and SNRI antidepressants
Rarely, taking a triptan with an SSRI or SNRI antidepressant has caused serotonin syndrome, a reaction that causes changes in your mental state, heart rate and muscle control.3,4 Tell your prescriber if you take one of these antidepressants.
Rizatriptan specifically: propranolol
Propranolol is widely used to prevent migraine and treat high blood pressure and heart conditions. It raises rizatriptan levels in your blood. If you take both, you'll need the 5mg dose of rizatriptan, taken at least two hours apart from propranolol. A prescriber must check this combination is suitable for you.4 Sumatriptan doesn't interact with propranolol.5
Can you take paracetamol or ibuprofen with triptans?
Yes. NICE recommends offering a triptan together with an NSAID, such as ibuprofen, or with paracetamol for a migraine attack.8
The two types of medicine work in different ways, so combining them can be worth discussing with your prescriber. Always read the patient information leaflet for both medicines before combining them.
Which is stronger: sumatriptan or rizatriptan?
In head-to-head trials, rizatriptan 10mg started working faster than sumatriptan 50mg. It also left more people pain-free at two hours than sumatriptan 100mg.1 Much more of each rizatriptan dose reaches your circulation, around 40 to 45% compared with around 14% for sumatriptan.4,5
That said, "stronger" isn't the same as "better for you". People respond to triptans very differently. Some who don't respond well to rizatriptan find sumatriptan works, and vice versa.
Migraine itself varies too. How severe attacks are, how fast they come on and what symptoms come with them differ from person to person, and from one attack to the next.
The format matters as well. Sumatriptan also comes as a nasal spray and an injection, which rizatriptan doesn't.
NICE guidance says that if one triptan is consistently ineffective, one or more alternative triptans should be tried.8 Tried sumatriptan without enough relief? Rizatriptan is a reasonable next step to discuss with your prescriber, and the reverse is true too. If you request treatment through Pharmica, the consultation asks whether a GP has diagnosed your migraine and whether triptans have relieved it before. Your prescriber must assess your answers and treatment history. The questions alone do not mean automatic approval, refusal or a particular dose.
Which should you choose?
Neither medicine is better for everyone. The right choice depends on your migraine pattern, the other medicines you take and how you prefer to take treatment.
Rizatriptan may suit you better if:
- Your migraines build quickly and you need relief as fast as possible
- You struggle to swallow tablets during an attack because of nausea (the melts dissolve without water)
- You're not taking propranolol
- Sumatriptan hasn't given you enough relief before
Sumatriptan may suit you better if:
- You'd like a pharmacy option for occasional use (50mg tablets, if you're aged 18 to 65 and already diagnosed)
- You want the flexibility of different formats: a nasal spray if nausea is severe, or an injection for very fast or severe attacks
- You're taking propranolol (no dose change needed with sumatriptan)
- Rizatriptan hasn't worked well enough, or its side effects have been hard to manage
In practice, the most reliable way to find the right triptan is to try it during an actual attack. See how well it works and how you feel, then talk it through with your prescriber. Many people try more than one triptan before settling on a favourite.
When to seek further advice
Call 999 straightaway if you have:
- Sudden weakness on one side of your body, difficulty speaking, sudden loss of vision or a sudden, extremely severe headache
- Chest pain that is severe or does not go away, especially if it spreads to your arm or jaw or comes with breathlessness
Do not take another triptan dose while you wait to be assessed.
Contact your GP or prescriber if you:
- Find that either medicine is not providing enough relief after two or three attacks
- Are using acute migraine treatment on 10 or more days a month, as this may lead to medication overuse headache
- Are pregnant or breastfeeding and need migraine relief, so you can discuss safe options
Frequently asked questions
What is the difference between sumatriptan and rizatriptan?
Both are triptans used to treat migraine attacks, but they differ in how quickly they work, their available formulations, and some of their interactions. Rizatriptan has a higher oral bioavailability (around 40 to 45% versus approximately 14% for sumatriptan) and reaches peak plasma concentration faster, which can mean a quicker onset of relief. Sumatriptan has the broader range of formulations (tablets, nasal spray and subcutaneous injection), and 50mg tablets are available over the counter as Imigran Recovery. Rizatriptan is prescription-only but comes as an orodispersible tablet (wafer/melt) that dissolves on the tongue without water.
Which works faster, sumatriptan or rizatriptan?
Rizatriptan generally reaches peak plasma concentration more quickly: within around one to one and a half hours of an oral dose compared to approximately two hours for sumatriptan tablets. In head-to-head clinical trials, a higher proportion of patients taking rizatriptan 10mg were pain-free at 60 and 120 minutes compared to those taking sumatriptan 50mg or 100mg.
Can I take sumatriptan and rizatriptan together?
No. Taking two triptans at the same time or within 24 hours of each other is contraindicated due to the risk of coronary artery vasoconstriction. If one triptan doesn't work for a particular attack, switch to a non-triptan painkiller such as paracetamol or ibuprofen for that attack. You can use a different triptan for a subsequent attack, but always discuss switching with your prescriber first.
Can I take paracetamol or ibuprofen with sumatriptan or rizatriptan?
Yes. NICE guidance recommends taking a triptan together with either paracetamol or an NSAID such as ibuprofen as the first-line approach to treating a migraine attack. Combination therapy is more effective than either medicine alone. Both sumatriptan and rizatriptan can be taken alongside either analgesic. Always read the patient information leaflet for both medicines before combining them.
Is rizatriptan stronger than sumatriptan?
In head-to-head clinical trials, rizatriptan 10mg showed greater efficacy than sumatriptan 50mg, with higher rates of pain freedom at two hours and a faster onset of action. However, individual responses to triptans vary considerably. Some people who don't respond well to rizatriptan find sumatriptan effective, and vice versa. If one triptan hasn't worked well for you, it's worth trying an alternative rather than assuming triptans as a class won't help.
Can I buy sumatriptan over the counter in the UK?
Yes, but only in the 50mg strength and in limited pack sizes. Sumatriptan 50mg is available as a pharmacy (P) medicine under the brand name Imigran Recovery. It can be purchased from a pharmacy without a prescription, but a pharmacist must approve the sale and will ask some questions to make sure it's suitable for you. The 100mg strength, nasal spray, and injection require a prescription, as does rizatriptan in all forms.
Can I take rizatriptan if I'm on propranolol?
Yes, but at a reduced dose. Propranolol significantly increases rizatriptan plasma concentrations by inhibiting the enzyme (MAO-A) that metabolises it. The recommended rizatriptan dose for anyone taking propranolol is 5mg rather than the standard 10mg, and you should allow at least two hours between doses of the two medicines. A prescriber must check this combination is suitable for you. Sumatriptan does not have this interaction with propranolol and does not require a dose adjustment.
What should I do if sumatriptan stops working?
First, make sure you're taking it as early as possible after the headache phase begins. Triptans are generally more effective when taken promptly. If sumatriptan consistently provides inadequate relief, speak to your GP or prescriber. NICE guidance supports switching to a different triptan if the first is ineffective or poorly tolerated, so rizatriptan would be a reasonable alternative to try. A higher dose of sumatriptan (100mg instead of 50mg) may also be worth discussing.
How long after taking sumatriptan or rizatriptan can I take another dose?
For both medicines, you must wait at least two hours before taking a second dose. A second dose is only appropriate if you had initial relief and the headache then returned. If the first dose provided no relief at all, do not take a second dose for the same attack. The maximum daily dose is 300mg for prescription sumatriptan tablets and 20mg for rizatriptan (10mg if you take propranolol). If you buy sumatriptan from a pharmacy without a prescription, follow its own leaflet and your pharmacist's directions.
References
- Tfelt-Hansen P, Ryan RE. Oral therapy for migraine: comparisons between rizatriptan and sumatriptan. A review of four randomized, double-blind clinical trials. Neurology. 2000;55(9 Suppl 2):S19-S24. pubmed.ncbi.nlm.nih.gov
- Teva UK Limited. Boots Migraine Relief 50 mg Tablets: Patient Information Leaflet. Electronic Medicines Compendium; 2026. medicines.org.uk/emc
- Dr. Reddy's Laboratories (UK) Ltd. Sumatriptan 50mg film-coated Tablets: Summary of Product Characteristics. Electronic Medicines Compendium; 2025. medicines.org.uk/emc
- Glenmark Pharmaceuticals Europe Ltd. Rizatriptan 10 mg Tablets: Summary of Product Characteristics. Electronic Medicines Compendium; 2026. medicines.org.uk/emc
- GlaxoSmithKline UK. Imigran 50mg Tablets: Summary of Product Characteristics. Electronic Medicines Compendium; 2025. medicines.org.uk/emc
- Organon Pharma (UK) Limited. Maxalt Melt 10 mg Oral Lyophilisates: Summary of Product Characteristics. Electronic Medicines Compendium; 2024. medicines.org.uk/emc
- Xu H, Han W, Wang J, et al. Network meta-analysis of migraine disorder treatment by NSAIDs and triptans. The Journal of Headache and Pain. 2016;17(1):113. doi:10.1186/s10194-016-0703-0
- National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management (CG150). NICE; 2025. nice.org.uk
This article is intended for informational purposes only and does not replace professional medical advice. Always read the patient information leaflet supplied with your medication and speak to a healthcare professional if you have specific concerns.