II. Indications
- Acute Migraine Headache
- Third-line agent in acute Migraine Headaches refractory to NSAIDS and Triptans
- Avoid for acute Migraines if also using Injectable CGRP Inhibitor for Migraine Prophylaxis
-
Migraine Prophylaxis
- Rimegepant (Nurtec) is FDA approved for Migraine Prophylaxis in 2021 (third-line agent)
- Injectable CGRP Inhibitors are also indicated in Migraine Prophylaxis
III. Mechanism
- Blocks CalcitoninGene-Related Peptide (CGRP)
- CGRP is a vasodilator and pain sensitizer that increases during Migraine Headaches
IV. Preparations
- Ubrogepant (Ubrelvy)
- Dose: 50-100 mg orally
- May repeat a second dose 2 hours after first)
- Maximum: 200 mg/24 hours
- Costs $85 per tablet (contrast with 70 cents per Sumatriptan tablet)
- May be repeated 2 hours after first dose if inadequate effect
- Dose: 50-100 mg orally
- Rimegepant (Nurtec)
- Migraine Abortive Treatment
- Dissolving oral tablet: 75 mg taken as single dose (maximum 75 mg/day)
- Migraine Prophylaxis
- Dissolving oral tablet: 75 mg taken every OTHER day (maximum 18 days per month)
- Breakthrough acute Migraine Headache should not be treated with Rimegepant
- Use another type of Migraine Abortive Treatment
- Cost: $1800/month (contrast with $630/month for Injectable CGRP Inhibitors)
- Migraine Abortive Treatment
V. Efficacy
-
Migraine Abortive Treatment
- NNT 10 for one patient to be pain free at 2 hours
- Contrast with NNT 5 for Sumatriptan
- NNT 10 for one patient to be pain free at 2 hours
-
Migraine Prophylaxis
- Rimegepant prevents 1 Migraine more than Placebo per month in those with 10 Migraines/month on average
- Similar efficacy to other Migraine Prophylaxis agents including Injectable CGRP Inhibitors
VI. Adverse Effects
VII. Drug Interactions
VIII. References
- (2020) Presc Lett 27(3): 13
- (2021) Presc Lett 28(8): 43-4
- LoVecchio (2020) Crit Dec Emerg Med 34(2):28
