Can I initiate treatment with Ubrelvy (ubrogepant) 100mg before starting with 50mg?

From the Guidelines

Yes, you can start someone on Ubrelvy 100mg without trying the 50mg dose first, as the decision to start with the 100mg dose should be based on individual patient factors such as severity of migraines, previous response to other medications, or anticipated need for stronger relief 1. Ubrelvy (ubrogepant) is an oral calcitonin gene-related peptide (CGRP) receptor antagonist approved for the acute treatment of migraine. The medication is suggested for the short-term treatment of migraine, according to the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline for the management of headache 1. Some key points to consider when prescribing Ubrelvy include:

• The maximum daily dose is 200mg, with no more than two doses within 24 hours, separated by at least 2 hours.
• Common side effects include nausea, tiredness, and dry mouth, though the higher dose may slightly increase the likelihood of these effects.
• The medication should be used with caution in patients with severe hepatic or renal impairment and those taking strong CYP3A4 inhibitors. It's essential to weigh the potential benefits and risks of starting with the 100mg dose and to monitor the patient's response and adjust the treatment plan as needed 1.

From the FDA Drug Label

The recommended dose of UBRELVY is 50 mg or 100 mg taken orally with or without food. If needed, a second dose may be taken at least 2 hours after the initial dose.

Starting Dose: The FDA drug label recommends starting with a dose of 50 mg or 100 mg.

• There is no requirement to start with the 50mg dose before taking the 100mg dose, the choice of initial dose is based on clinical judgment.
• Key Consideration: The decision to start with 100mg should be based on individual patient needs and medical history, considering the potential for adverse reactions and the efficacy of the lower dose. 2 2

From the Research

Ubrogepant Dosage

• The studies do not provide direct evidence on whether to start someone on Ubrelvy 100mg before the 50mg dose 3, 4, 5.
• However, the studies suggest that Ubrogepant can be administered as 50- and 100-mg tablets, with a maximum dose of 200 mg within 48 hours 4.
• One study found that a higher percentage of participants who received Ubrogepant 100mg had freedom from pain and absence of the most bothersome symptom at 2 hours after the dose, compared to those who received the 50mg dose 3.

Efficacy and Safety

• Ubrogepant has been shown to be effective in treating acute migraine attacks, with a significant percentage of participants achieving freedom from pain and absence of the most bothersome symptom at 2 hours after the dose 3, 4, 5.
• The most common adverse events reported with Ubrogepant include nausea, somnolence, and dry mouth, which were more frequent in the 100mg group 3.
• Ubrogepant has been found to be well-tolerated, with no serious adverse events related to the treatment reported in the studies 3, 4, 5.

Dosing Considerations

• The studies do not provide specific guidance on whether to start someone on the 100mg dose before the 50mg dose, but they do suggest that the 100mg dose may be more effective for some patients 3.
• However, the decision to start someone on the 100mg dose should be based on individual patient needs and medical history, and should be made in consultation with a healthcare professional 3, 4, 5.