II. Indications

  1. Acute Migraine Headache
    1. Third-line agent in acute Migraine Headaches refractory to NSAIDS and Triptans

III. Mechanism

  1. Blocks CalcitoninGene-Related Peptide (CGRP)
    1. CGRP is a vasodilator and pain sensitizer

IV. Preparations

  1. Ubrogepant (Ubrelvy)
    1. Dose: 50-100 mg orally
      1. May repeat a second dose 2 hours after first)
      2. Maximum: 200 mg/24 hours
    2. Costs $85 per tablet (contrast with 70 cents per Sumatriptan tablet)
    3. May be repeated 2 hours after first dose if inadequate effect
  2. Rimegepant (Nurtec)
    1. Dissolving oral tablet: 75 mg taken as single dose (maximum 75 mg/day)

V. Efficacy

  1. NNT 10 for one patient to be pain free at 2 hours
    1. Contrast with NNT 5 for Sumatriptan

VI. Adverse Effects

VII. Drug Interactions

  1. CYP3A4 Agents
    1. Drug levels may be increased by strong CYP3A4 inhibitors
    2. Drug levels may be decreased by CYP3A4 inducers (e.g. Phenytoin, Rifampin, St. John's Wort)

VIII. References

  1. (2020) Presc Lett 27(3): 13
  2. LoVecchio (2020) Crit Dec Emerg Med 34(2):28

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