Use in Adults
Gepants
THIS GUIDE PROVIDES A PARTIAL LISTING OF PRESCRIBING INFORMATION FOR THIS MEDICATION. FOR A FULL LISTING OF PRESCRIBING INFORMATION PLEASE REFER TO THE PACKAGE INSERT. CLICK ON THE BRAND NAME® TO VIEW THE LINK TO THE PACKAGE INSERT.
Rimegepant (Nurtec®) Click Here to Expand
Brands:
- Nurtec® ODT (rimegepant sulfate) For more complete prescribing information click here for PACKAGE INSERT
- 75 mg
- 75 mg under the tongue at onset of migraine as needed for the treatment of an acute migraine attack
- 75 mg
- Nausea, abdominal pain, indigestion
- The main advantages of the gepants are their good efficacy & tolerability and minimal to no risk for medication overuse headache. Also, they do not have a cardiovascular contraindication like the triptans.
- There is no evidence from clinical studies that gepants are more efficacious than triptans, ditans or ergots.
- The main disadvantages are their expense and need for a prior authorization in many cases.
- Patients may need to “try and fail” 1-2 triptans before insurance approval.
- Consider their use as primary treatment of the migraine attack in following situations:
- Patients whose triptan does not provide adequate pain relief at 2 hours
- Patients who are intolerant of triptans
- Patients who have medication overuse headache (e.g., those that using acute medications ≥ 10 days per month)
- Patients in whom triptans are contraindicated, particularly for patients with cardiovascular contraindications, since the gepants do not have a cardiovascular contraindication.
- Hypersensitivity reactions
- Avoid in those taking strong CYP3A4 inhibitors (see Drug Interactions)
- Click Nurtec® and navigate to #8 Use in Specific Populations (8.1 & 8.2)
- Strong CYP3A4 Inhibitors: may increase serum levels of rimegepant. Consider avoidance if taking these medications: clarithromycin, protease inhibitors and antifungals (e.g., itraconazole and ketoconazole) among others.
- Moderate CYP3A4 Inhibitors: Avoid another dose within 48 hours when administered with a moderate CYP3A4 inhibitor. These drugs include verapamil, erythromycin, diltiazem, amiodarone, among others.
- Strong and moderate CYP3A Inducers: May decrease serum concentration of rimegepant. These include carbamazepine, phenytoin, phenobarbital, St. John’s wort and others.
- Inhibitors of P-gp or BCRP: Avoid concomitant administration. Consider avoidance if taking these medications: amiodarone, clarithromycin, cyclosporin, colchicine, diltiazem, erythromycin, felodipine, ketoconazole, lansoprazole, omeprazole and others.
- Keep the tablet in the blister/outer aluminum pouch until ready to use
- Allow tablet to disintegrate on or under the tongue
- Take early in the attack when the pain is mild
Ubrogepant (Ubrelvy®) Click Here to Expand
Brands: Initial Dose:
- 50 mg
- 50 mg by mouth at onset of migraine as needed for the treatment of an acute migraine attack; may repeat dosage in two hours, if not pain free or with adequate relief
- 100 mg tablet can be used as the initial dosage if the 50 mg dosage does not provide pain freedom or adequate pain relief
- 200 mg
- Nausea and somnolence
- The main advantages of the gepants are their good efficacy & tolerability and minimal to no risk for medication overuse headache. Also, they do not have a cardiovascular contraindication like the triptans.
- There is no evidence from clinical studies that gepants are more efficacious than triptans, ditans or ergots.
- The main disadvantages are their expense and the requirement for prior authorization.
- Patients may need to “try and fail” 1-2 triptans before insurance approval.
- Consider their use as primary treatment of the migraine attack in following situations:
- Patients whose triptan does not provide adequate pain relief at 2 hours
- Patients who are intolerant of triptans
- Patients who have medication overuse headache (e.g., those who are using acute medications ≥ 10 days per month)
- Patients where triptans are contraindicated, particularly for patients with cardiovascular contraindications, since the gepants do not have a cardiovascular contraindication.
- Avoid in patients with end stage renal disease
- Hypersensitivity reactions
- Avoid in those taking strong CYP3A4 inhibitors (see Drug Interactions)
- Click Ubrelvy® and navigate to #8 Use in Specific Populations (8.1 & 8.2)
- Strong CYP3A4 Inhibitors: may increase serum levels of rimegepant. Consider avoidance if taking these medications. These include clarithromycin, protease inhibitors and antifungals (e.g., itraconazole and ketoconazole) and others.
- Moderate CYP3A4 Inhibitors: Avoid another dose within 48 hours when administered with a moderate CYP3A4 inhibitor. These drugs include verapamil, erythromycin, diltiazem, amiodarone and others.
- Strong and moderate CYP3A Inducers: May decrease serum concentration of rimegepant. These medications include carbamazepine, phenytoin, phenobarbital, St. John’s wort and others.
- Inhibitors of P-gp or BCRP: Avoid concomitant administration. These medications include amiodarone, clarithromycin, cyclosporin, , colchicine, diltiazem, erythromycin, felodipine, ketoconazole, lansoprazole, omeprazole and others.
- Take early in the attack when the pain is mild