Drug Interaction Between Ubrelvy (Ubrogepant) and Curcumin
Curcumin increases ubrogepant exposure and requires dose adjustment when used concomitantly with Ubrelvy. 1
Mechanism of Interaction
Ubrogepant is a substrate of BCRP (breast cancer resistance protein) and P-glycoprotein (P-gp) efflux transporters. Curcumin acts as an inhibitor of both BCRP and P-gp, which can increase the systemic exposure of ubrogepant when taken together 1.
Dosing Recommendations
When taking curcumin with Ubrelvy, reduce the ubrogepant dose to 50 mg initially. If needed for additional efficacy, a second 50 mg dose may be taken at least 2 hours after the initial dose, but avoid taking a second dose within 24 hours when using BCRP/P-gp inhibitors like curcumin 1.
Predicted Exposure Changes
The FDA label indicates that the maximum predicted increase in ubrogepant exposure with BCRP and/or P-gp inhibitors is not expected to exceed 2-fold 1. While no dedicated clinical study was conducted specifically with curcumin, the dose adjustment recommendation is based on:
- Conservative modeling from ADME studies
- Clinical interaction studies with combined CYP3A4/P-gp inhibitors
- The known inhibitory effects of curcumin on these transporters 2, 3
Clinical Significance
The interaction is clinically meaningful because:
- Increased ubrogepant exposure could potentially increase adverse events
- The FDA specifically lists curcumin as an example of a BCRP/P-gp inhibitor requiring dose adjustment 1
- Curcumin is known to inhibit multiple drug-metabolizing enzymes and transporters, though its effects vary depending on formulation and dosing 2, 3
Important Caveats
Curcumin's interaction potential varies significantly based on:
- Formulation and bioavailability: Standard curcumin has poor oral bioavailability; enhanced formulations may have greater interaction potential
- Dosing: Higher curcumin doses are more likely to cause clinically relevant interactions
- Duration of use: Chronic curcumin supplementation may have different effects than occasional use
The evidence for curcumin drug interactions comes primarily from in vitro and animal studies 2, 3, with limited human clinical trial data. However, the FDA's conservative approach in labeling curcumin as a BCRP/P-gp inhibitor requiring dose adjustment reflects appropriate caution given ubrogepant's substrate status.
Safety Profile
When dose-adjusted appropriately, ubrogepant has demonstrated good tolerability across multiple clinical trials 4, 5. The most common adverse events are generally mild and include nausea, somnolence, and dry mouth. No new safety signals emerged when ubrogepant was studied in combination with other medications 6, 7.
Bottom line: Do not use the standard 100 mg dose of Ubrelvy when taking curcumin supplements. Start with 50 mg and limit dosing frequency as outlined above to avoid excessive ubrogepant exposure.