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 is the most widely prescribed triptan in the UK, and has been licensed for migraine since 1991. It's sold under the brand name Imigran.
Sumatriptan 50mg tablets can be bought from pharmacies without a prescription if you've been diagnosed with migraine, which makes it one of the few prescription-class migraine treatments with this status. Higher doses (100mg) 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 licensed to prevent migraine. You take them once a headache has started, not as a daily preventive.1,2
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 nerve endings of the trigeminal nerve, which plays a central role in migraine pain.
During a migraine attack, blood vessels in the brain widen and the trigeminal nerve releases inflammatory substances, including calcitonin gene-related peptide (CGRP). Together, these drive the throbbing pain, nausea and light sensitivity of a migraine.
Both medicines bind to 5-HT1B receptors on blood vessels in the head, making them narrow. They also bind to 5-HT1D receptors on the trigeminal nerve endings, reducing the release of those pain-amplifying substances. The result is relief from headache pain, nausea and sensitivity to light and sound.3
The way they work is the same. The practical differences come from how quickly each one reaches effective levels in your bloodstream.
Sumatriptan vs rizatriptan: key differences at a glance
|
Sumatriptan |
Rizatriptan |
| Licensed dose (oral) |
50mg to 100mg |
10mg (5mg if taking propranolol) |
| Time to peak plasma concentration |
Around 2 hours (oral tablet) |
Around 1 to 1.5 hours (oral tablet) |
| 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) |
No (prescription-only) |
| Max dose per 24 hours |
300mg (tablets) |
20mg (10mg if taking propranolol) |
| Caution with propranolol |
No dose adjustment needed |
Reduce to 5mg |
How quickly does each work?
For most people, how fast each one works is the most meaningful difference.
Rizatriptan reaches its peak level in your blood around one to one and a half hours after a tablet. Around 40 to 45% of each dose reaches your circulation, so more of the medicine gets where it needs to go.4
Clinical studies have found that some people start to feel real relief within 30 minutes of taking rizatriptan 10mg, and a good proportion are pain-free at one hour.
Sumatriptan is absorbed less well. Only around 14% of a tablet dose reaches your circulation, largely because a lot of it is broken down in your liver and gut wall first.4
Levels from a standard 50mg tablet peak at around two hours. But most people start to feel it working sooner, at around 30 to 60 minutes.5
In four randomised head-to-head trials of the tablets, rizatriptan 10mg worked faster than sumatriptan 50mg and 100mg, and more people were pain-free at 60 and 120 minutes with rizatriptan.3
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 headache starts. Some people find 100mg works better, while others do well on 50mg.
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 in any 24 hours is 300mg.5
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.
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 a second 10mg dose, again with at least two hours between doses. The maximum in 24 hours is 20mg.2
A lower 5mg dose is recommended if you also take propranolol, a beta-blocker often used to prevent migraine. Propranolol raises rizatriptan levels in your blood, because the two share a breakdown pathway (an enzyme called MAO-A). Lowering the dose manages this interaction.2
Food can slow how quickly rizatriptan is absorbed, so it may work a little faster on an empty stomach.2
Do not take a second triptan dose if the first didn't 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 prescribed form
- Nasal spray (10mg, 20mg) - useful if nausea stops you swallowing tablets; absorbed faster than tablets, but less effective overall than the injection^6^
- Injection under the skin (6mg) - the fastest-acting format, usually bringing real relief within 10 minutes; generally kept for severe or fast-peaking attacks^6^
Rizatriptan comes as:
- Standard tablets (5mg, 10mg) - swallowed with water
- Orodispersible tablets (wafers or melts; 5mg, 10mg) - 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, they can take a little longer to peak, because the medicine is still swallowed and absorbed from your gut.2 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 with both include:1,2
- Tingling, warmth, heaviness or pressure, especially in the face, limbs or chest
- Flushing
- Dizziness or drowsiness
- Nausea
- Dry mouth
- Tiredness or weakness
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's usually short-lived and harmless, but it can be hard to tell apart from a heart symptom.
If chest pain is severe, doesn't pass within a few minutes, or comes with other symptoms like pain spreading to your arm or jaw, stop taking the medicine and seek urgent medical advice.1
Some comparative data suggest sumatriptan causes side effects more often than some other triptans, including almotriptan.7 But everyone responds differently, and how well you tolerate a triptan is partly personal.
Medication overuse headache is a risk with any treatment for migraine attacks, including both triptans. NICE defines medication overuse as taking triptans on 10 or more days a month, or paracetamol or NSAIDs on 15 or more days a month.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 pain that's severe, doesn't pass quickly, or spreads to your arm or jaw? Stop the medicine and get urgent medical 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 rizatriptan, wait at least six hours before taking any ergotamine-type medicine.1,2
Both medicines: MAOIs
Both sumatriptan and rizatriptan must not be used if you take monoamine oxidase inhibitors (MAOIs), a type of antidepressant. MAOIs block the enzymes that break down triptans, raising their levels and the risk to your heart. The same caution applies for two weeks after stopping an MAOI.
Rizatriptan specifically: propranolol
Propranolol is widely used to prevent migraine and treat high blood pressure and heart conditions. It significantly raises rizatriptan levels in your blood. This is an important interaction: your rizatriptan dose must be reduced to 5mg if you also take propranolol.2 Sumatriptan doesn't have this interaction.
Can you take paracetamol or ibuprofen with triptans?
Yes. You can take sumatriptan or rizatriptan alongside paracetamol or an NSAID like ibuprofen.
Combining a triptan with an NSAID may improve migraine relief overall, because the two types of medicine target different parts of the attack. Always read the patient information leaflet for both medicines before combining them.
Which is stronger: sumatriptan or rizatriptan?
In randomised head-to-head trials, rizatriptan 10mg worked better than sumatriptan 50mg, with more people pain-free at two hours and faster relief.3 Much more of each rizatriptan dose reaches your circulation, around 40 to 45% compared with around 14% for sumatriptan.4
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's injection peaks faster than any rizatriptan tablet, and it's the most effective triptan format for treating an attack.
NICE guidance recognises that if one triptan doesn't work or doesn't agree with you, switching to another triptan is appropriate.8 Tried sumatriptan without enough relief? Rizatriptan is a reasonable next step, and the reverse is true too.
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 and have no history of taking MAOIs
- Sumatriptan hasn't given you enough relief before
Sumatriptan may suit you better if:
- You'd like an over-the-counter option for occasional use (50mg tablets, branded Imigran Recovery)
- 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
Contact your GP or prescriber if you:
- Find that either medicine is not providing adequate relief after two or three attacks
- Experience chest pain or tightness that is severe, prolonged, or accompanied by other symptoms such as arm pain or breathlessness
- Are using acute migraine treatment on more than 10 to 15 days per month, as this may indicate medication overuse headache
- Have new symptoms alongside your headache (weakness on one side, speech difficulty, visual loss, or the worst headache of your life), as these require urgent medical review and may indicate something other than migraine
- Are pregnant or breastfeeding and need migraine relief; discuss safe options with your GP
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 40–45% 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. That said, sumatriptan's subcutaneous injection is the fastest-acting triptan formulation available and reaches peak effect within around 10 minutes - faster than any oral rizatriptan dose.
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?
A: 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. 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 sumatriptan tablets and 20mg for rizatriptan.
References
- Dr. Reddy's Laboratories (UK) Ltd. Sumatriptan 50mg film-coated Tablets, Summary of Product Characteristics. Electronic Medicines Compendium (eMC). medicines.org.uk/emc/product/3521/smpc
- Rizatriptan 10mg Tablets, Summary of Product Characteristics. Electronic Medicines Compendium (eMC). medicines.org.uk/emc/product/9893/smpc
- Tfelt-Hansen P, et al. Oral therapy for migraine: comparisons between rizatriptan and sumatriptan. A review of four randomized, double-blind clinical trials. Cephalalgia. 2000;20(10):887-893. PMID:11089515
- Tfelt-Hansen P, et al. Triptans in migraine: a comparative review of pharmacology, pharmacokinetics and efficacy. Drugs. 2000;60(6):1259-1287. PMID:11152011
- Imigran 50mg Tablets (sumatriptan), Summary of Product Characteristics. Electronic Medicines Compendium (eMC). medicines.org.uk/emc/product/945/smpc
- Sumatriptan 50mg film-coated Tablets, Summary of Product Characteristics. Electronic Medicines Compendium (eMC). medicines.org.uk/emc/product/12390/smpc
- Mo Y, et al. Network meta-analysis of migraine disorder treatment by NSAIDs and triptans. Journal of Headache and Pain. 2016;17(1):113. doi:10.1186/s10194-016-0703-0
- National Institute for Health and Care Excellence (NICE). Headaches in over 12s: diagnosis and management. Clinical guideline CG150. Last updated June 2025. nice.org.uk/guidance/cg150
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.