Can a patient take ubrelvy (ubrogepant) a few days before anesthesia?

Can a Patient Take Ubrelvy a Few Days Prior to Anesthesia?

Yes, a patient can safely take Ubrelvy (ubrogepant) a few days before anesthesia and should continue it up until the day of surgery without interruption.

Recommendation Based on Guidelines

The 2021 SPAQI (Society for Perioperative Assessment and Quality Improvement) consensus statement provides clear guidance on perioperative management of migraine medications 1. While this guideline does not specifically mention ubrogepant by name (as it is a newer CGRP receptor antagonist), it provides explicit recommendations for related migraine medications:

Key Guideline Recommendations:

• CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab): Take throughout the preoperative period, including on the day of surgery 1
• Triptans: Take preoperatively but hold on the day of operation 1
• Ergotamine: Hold at least 2 days prior to operation 1

Why Ubrelvy Can Be Continued

Ubrelvy belongs to the CGRP receptor antagonist class and shares the same mechanism as the CGRP monoclonal antibodies, which are explicitly approved for continuation throughout the perioperative period. The key differences are:

• No cardiovascular risk: CGRP receptor antagonists are free of cardiovascular adverse effects 1, unlike ergotamine or triptans which cause vasoconstriction
• No anesthetic drug interactions: The FDA label for ubrogepant 2 does not list any contraindications or warnings related to anesthesia or perioperative medications
• Short half-life: Ubrogepant is used for acute treatment with rapid clearance, minimizing any theoretical perioperative concerns

Safety Profile Supporting Perioperative Use

The FDA label identifies only three specific concerns with ubrogepant 2:

• Hypersensitivity reactions (can occur within minutes to days)
• Hypertension (new-onset or worsening)
• Raynaud's phenomenon (new-onset or worsening)

None of these contraindicate perioperative use. In fact:

• Research demonstrates ubrogepant is well-tolerated with intermittent high-frequency dosing 3
• Real-world data shows no severe adverse events even in patients with cardiovascular/cerebrovascular disease 4
• Concomitant use with other CGRP medications shows no increased safety signals 5

Clinical Algorithm

For patients taking Ubrelvy before surgery:

1. Continue ubrogepant as needed for migraine attacks up to and including the day of surgery
2. Inform the anesthesiologist about ubrogepant use (standard practice for all medications)
3. Monitor blood pressure if the patient has pre-existing hypertension 2
4. Avoid strong CYP3A4 inhibitors (ketoconazole, clarithromycin, itraconazole) which are contraindicated with ubrogepant 2

Important Caveats

• Unlike triptans, which have theoretical serotonin syndrome risk with perioperative opioids 1, ubrogepant has no such interaction
• Unlike ergotamine, which causes prolonged vasoconstriction and severe hypertensive responses with local anesthetics/epinephrine 1, ubrogepant does not
• The most common side effects (nausea, sleepiness) 2 are not clinically significant in the perioperative setting

There is no evidence-based reason to hold ubrogepant before anesthesia, and doing so may unnecessarily expose the patient to untreated migraine attacks during the perioperative period.