What is Nurtec (Rimegepant)?

From the Guidelines

Nurtec (rimegepant) is an effective medication for both acute treatment and prevention of migraine headaches, and it should be considered for patients who do not tolerate or have inadequate response to combination therapy of a triptan and an NSAID or acetaminophen, as recommended by the American College of Physicians 1. For acute treatment, take one 75 mg tablet at the onset of migraine symptoms, with a maximum of one dose per 24 hours. For prevention, take one 75 mg tablet every other day. Nurtec works quickly, typically providing relief within 1-2 hours, and doesn't require water for administration as it dissolves on or under the tongue. As a CGRP receptor antagonist, it blocks the action of calcitonin gene-related peptide, a key protein involved in migraine pain. Common side effects include nausea and stomach discomfort. Nurtec is generally well-tolerated but should be avoided by patients with severe kidney or liver disease and those taking strong CYP3A4 inhibitors. Unlike traditional triptans, Nurtec doesn't cause medication overuse headaches and has no cardiovascular restrictions, making it suitable for patients with heart conditions who cannot take triptans 1.

Some key points to consider when prescribing Nurtec include:

• Counseling patients to begin treatment of migraine headache as soon as possible after its onset, using combination therapy to improve efficacy 1.
• Being aware of medication overuse headache, which is a potential complication of migraine treatment, and informing patients about the risks and symptoms 1.
• Highlighting the importance of lifestyle modifications, including staying well hydrated, maintaining regular meals, securing sufficient and consistent sleep, and managing stress with relaxation techniques or mindfulness practices 1.

Overall, Nurtec is a valuable treatment option for patients with migraine headaches, and its use should be considered in the context of individual patient needs and preferences, as well as the latest clinical guidelines and evidence-based recommendations 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Overview of Nurtec

• Nurtec, also known as Rimegepant, is a calcitonin gene-related peptide (CGRP) receptor antagonist approved for the acute treatment of migraine with or without aura in adults, and for the preventive treatment of episodic migraine in adults 2.
• It is available as an orally disintegrating tablet (ODT), which offers convenience and a potentially faster response time than the conventional tablet formulation 2, 3.

Efficacy of Nurtec

• Rimegepant has been shown to significantly improve freedom from pain at 2 hours after the dose and freedom from the most bothersome symptom 2 hours postdose 3.
• It has also been shown to reduce the number of monthly migraine days when taken every other day for the preventive treatment of migraine 2.
• The beneficial effects of rimegepant in reducing migraine frequency and improving quality of life were maintained over the longer term (up to 52 weeks) 2.

Safety and Tolerability of Nurtec

• Rimegepant was generally well tolerated, with no evidence of hepatotoxicity or cardiovascular toxicity in clinical trials 2.
• Adverse effects of rimegepant include nausea, urinary tract infection, and dizziness 3.
• Long-term and real-world data of tolerability, safety, and efficacy of rimegepant is consistent with prior studies, but more longitudinal data is needed to clarify long-term safety 4.

Comparison with Other Treatments

• Rimegepant has been compared to other treatments such as ubrogepant and lasmiditan in network meta-analyses, which suggest that it has a favorable benefit-risk profile 5, 6.
• Rimegepant had the lowest number needed to treat (NNT) to achieve sustained pain freedom at 2 to 24 hours and lasmiditan 50 mg had the highest 5.
• The efficacy results were similar for rimegepant and lasmiditan, with rimegepant having higher rates of pain freedom and relief than lower doses of lasmiditan, while somnolence and dizziness outcomes were lower for rimegepant than higher doses of lasmiditan 6.