II. Indications
- Acute Migraine Headache
- Third-line agent in acute Migraine Headaches refractory to NSAIDS and Triptans
III. Mechanism
- Blocks CalcitoninGene-Related Peptide (CGRP)
- CGRP is a vasodilator and pain sensitizer
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)
- Dissolving oral tablet: 75 mg taken as single dose (maximum 75 mg/day)
V. Efficacy
- NNT 10 for one patient to be pain free at 2 hours
- Contrast with NNT 5 for Sumatriptan
VI. Adverse Effects
VII. Drug Interactions
VIII. References
- (2020) Presc Lett 27(3): 13
- LoVecchio (2020) Crit Dec Emerg Med 34(2):28
