Nurtec is the first drug approved for acute and preventive treatment of migraines.
Biohaven, the manufacturer of rimegepant (Nurtec ODT) just received FDA approval to market this drug for the prevention of migraines. Rimegepant was approved in January of 2020 for the acute treatment of migraine headaches. It is the first drug to be approved for both acute and preventive therapy of migraines.
Rimegepant is one of six drugs that block the action of calcitonin gene-related peptide (CGRP). CGRP has many important functions in the body but the release of excessive amounts of it in the brain can trigger a migraine. Four of the CGRP migraine drugs are given by injection and they are used only for the prevention of migraine attacks. Rimegepant and ubrogepant (Ubrelvy) are taken by mouth as needed, whenever a migraine strikes. These are truly novel drugs that have dramatically improved the lives of many migraine sufferers.
Rimegepant stays in the body longer – it has a half-life of 10-12 hours, while ubrogepant’s half-life is 7-8 hours. Another difference is that rimegepant dissolves in your mouth (ODT after Nurtec stands for orally disintegrating tablet), while ubrogepant is a solid tablet that is swallowed.
In clinical trials, rimegepant was noticed to provide relief of migraine that persisted for up to 48 hours. Because of this sustained effect, the researchers decided to test this drug for the prevention of migraine attacks by giving it every other day. And rimegepant passed this test. The official FDA-approved label says that for the prevention of migraines, one tablet of rimegepant should be taken every other day. For the acute treatment of migraines, the directions say to take 1 tablet a day, as needed.
The insurers typically pay for 8 tablets a month, although a few of my patients have been able to get 16. Now, with its approval for the prevention, patients will be able to get 16 tablets a month. It is possible that some patients may be able to get an additional 8 tablets for acute therapy. For most, however, 16 tablets a month should be sufficient.
The safety profile of rimegepant (as well as ubrogepant) is truly remarkable. The new rimegepant label states that “The most common side effects of NURTEC ODT were nausea (2.7%) and stomach pain/ indigestion (2.4%).” It also states that these are not the only possible side effects but their frequency is very low. Just like with any drugs, an allergic reaction is also possible.
Yes, I do prescribe Nurtec and Ubrelvy for abortive therapy in patients who receive injectable CGRP monoclonal antibodies.
Dr. Mauskop, any thoughts on how nurtec as a rescue med pairs with one of the four CGRP injectables as a preventative? Thanks!
I have chronic migraine and was interested in trying Nurtec for prevention as I had a hypersensitivity reaction to Ajovy, which had helped. However, my doctor said it is only FDA approved for episodic migraine. Can you comment on using it off-label for CM? Is there any data on it? I tried to research it and it looks like they defined headache days as “moderate to severe” so maybe some of the study participants had CM because they had 14 moderate to severe headaches per month and 8 mild headaches per month, but they did not count the mild days?! Do you think it will get the indication later for CM?
Nurtec is definitely not the same as Emgality. All four injectable and two oral CGRP drugs are unique. Many patients find one works better than another. Sometimes, one may not work at all while another gives dramatic relief. So we try them all to see which one works better. Atogepant will be just another option to try.
I asked my doctor – a headache specialist – about switching from my Emgality to Nurtec ODT. He said they are essentially the same – just different delivery systems – so there would be no benefit. Do you agree? He is more interested in waiting for the approval of Atogepant, which he says the research shows is a game-changer. Your take? Thank you so much.