Rakdos Madness Burn plays similarly to Mono-Red Madness with the addition of Alms of the Vein for significant life drain, making it even more important to disrupt their damage pipeline early and race to stabilize with your large artifact threats. Breath Weapon handles Kitchen Imp, Voldaren Epicure, and Sneaky Snacker — the creatures that enable the madness chain — preventing them from generating repeated triggers off Alms of the Vein or Fiery Temper. Pyroblast answers their red spells on the stack and can counter Fiery Temper when it's being cast for its madness cost, which is the most mana-efficient disruption available. Duress is too slow here since they empty their hand quickly and the damage is already being dealt before you'd normally cast it. Focus on blocking early with Refurbished Familiar and Blood Fountain to preserve your life total, since Alms of the Vein makes their burn package hit considerably harder than straight Mono-Red.