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Calcitonin Gene-Related Peptide Blocker
Aka: Calcitonin Gene-Related Peptide Blocker, CGRP Antagonist, Injectable Calcitonin Gene-Related Peptide Blocker, Injectable CGRP Inhibitor, Erenumab, Ajovy, Fremanezumab, Emgality, Galcanezumab, Aimovig
- See Also
- Gepant (Oral CGRP Inhibitor)
- Migraine Prophylaxis
- Indications
- Migraine Prophylaxis if refractory to first-line agents
- Mechanism
- CGRP Antagonists block CGRP activity (vasodilator)
- CalcitoninGene-Related Peptide (CGRP) levels increases at Migraine Headache onset
- Vasodilator
- Pain sensitizer
- Preparations
- Erenumab (Aimovig) autoinjector
- Inject SQ once monthly in Abdomen, thigh, upper arm
- Ajovy (Fremanezumab)
- Three injections from prefilled syringes once every 3 months
- Emgality (Galcanezumab)
- Once monthly injection via pen
- Adverse Effects
- Injection site mild reactions
- New onset or worsening Hypertension (Erenumab or Aimovig)
- Associated with 60 cases of systolic increase of 40 mmHg, diastolic increase of 30 mmHg
- Occurred within 1 week of first or second dose
- May be related to the blockade of CGRP which is a vasodilator
- Avoid in Uncontrolled Hypertension or significant cardiovascular risk
- Incorporate Home Blood Pressure Monitoring for the first few months after starting
- (2021) Presc Lett 28(4): 19-20
- Saely (2021) Headache 61(1):202-8 [PubMed]
- Efficacy
- Reduces migraine Incidence by 2 fewer Migraine days/month
- Disadvantages
- Limited safety data outside healthy patients without comorbidity at time of 2018 release
- Expensive: $6900 per year
- References
- (2018) Presc Lett 25(8)
- (2018) Presc Lett 25(12): 70