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. Costs $85 per tablet (contrast with 70 cents per Sumatriptan tablet)
    2. 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 Substrate (Rimegepant)
    1. Drugs levels may be increased by strong CYP3A4 inhibitors

VIII. References

  1. (2020) Presc Lett 27(3): 13

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