What is the recommended treatment for migraine attacks using Nurtec (rimegepant)?

From the Guidelines

Nurtec (rimegepant) is recommended for the acute treatment of migraine attacks at a dose of 75 mg taken orally as a single tablet at the onset of migraine pain. This recommendation is based on the most recent and highest quality study available, which suggests the use of CGRP antagonists, such as rimegepant, for the treatment of moderate to severe acute episodic migraine headache in nonpregnant outpatient adults who do not tolerate or have inadequate response to combination therapy of a triptan and an NSAID or acetaminophen 1. The medication can be taken with or without food, and no more than one dose should be taken in a 24-hour period. Patients should not exceed 75 mg in a 24-hour period or use more than 15 doses per month to avoid medication overuse headache.

Some key points to consider when using Nurtec for migraine treatment include:

• The medication works as a calcitonin gene-related peptide (CGRP) receptor antagonist, blocking the CGRP pathway that plays a key role in migraine pain transmission.
• Relief typically begins within 1-2 hours after taking the medication, and the effects can last up to 48 hours for many patients.
• Nurtec can be used as needed for migraine attacks and doesn't require daily dosing like preventive medications.
• If a patient experiences severe side effects such as hypersensitivity reactions or if the medication is ineffective after several trials, they should consult their healthcare provider to discuss alternative treatment options.
• It is essential to counsel patients on the importance of lifestyle modifications, including staying well hydrated, maintaining regular meals, securing sufficient and consistent sleep, engaging in regular physical activity, managing stress with relaxation techniques or mindfulness practices, and avoiding medication overuse headache 1.

In terms of prevention, the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline for the management of headache suggests several options, including candesartan or telmisartan, erenumab, fremanezumab, or galcanezumab, but notes that there is insufficient evidence to recommend for or against rimegepant for the prevention of episodic migraine 1. However, for acute treatment, rimegepant is a viable option, and its use should be considered in the context of individual patient needs and preferences.

From the FDA Drug Label

1 INDICATIONS AND USAGE

1.1 Acute Treatment of Migraine NURTEC ODT is indicated for the acute treatment of migraine with or without aura in adults.

The recommended treatment for migraine attacks using Nurtec (rimegepant) is a 75 mg dose for the acute treatment of migraine in adults 2.

• The dosage form is an orally disintegrating tablet.
• There is no explicit dosage frequency or duration for acute treatment in the provided label.

From the Research

Recommended Treatment for Migraine Attacks using Nurtec (Rimegepant)

• Nurtec (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 3.
• The recommended dosage of Nurtec for acute treatment of migraine is 75mg, taken as needed 4, 5.
• Clinical trials have shown that rimegepant is effective in relieving pain and the most bothersome symptom when taken as needed for the acute treatment of migraine 3, 4, 6, 5.
• Rimegepant has been found to be generally well-tolerated, with common adverse events including nausea, urinary tract infection, and dizziness 3, 6, 5.

Efficacy of Nurtec in Acute Treatment of Migraine

• Studies have shown that rimegepant is more effective than placebo in achieving pain freedom and freedom from the most bothersome symptom at 2 hours post-dose 4, 6, 5.
• Rimegepant has also been shown to improve other outcomes, including freedom from photophobia and phonophobia, and pain relief at 2 hours post-dose 6.
• The efficacy of rimegepant has been demonstrated in various patient populations, including adults with a history of migraine and those with contraindications to triptans or unable to tolerate their adverse effects 3, 6.

Safety and Tolerability of Nurtec

• Rimegepant has been found to be generally well-tolerated, with no evidence of hepatotoxicity or cardiovascular toxicity in clinical trials 3.
• The most common adverse events associated with rimegepant include nausea, urinary tract infection, and dizziness 3, 6, 5.
• Rimegepant has been shown to have a favorable safety profile, making it a useful option for the management of migraine in adults 3, 7.