From the Guidelines
Nurtec (rimegepant) should be used with caution in patients with Acute Coronary Syndrome (ACS), as it is not absolutely contraindicated but has important cardiovascular considerations. The medication has not been extensively studied in patients with cardiovascular disease, as most clinical trials excluded patients with significant cardiovascular risk factors or recent cardiovascular events 1. For patients with established ACS, alternative migraine treatments should be considered first. If Nurtec must be used in a patient with recent ACS, it would be prudent to ensure the patient is stabilized, consult with their cardiologist, and monitor for any cardiovascular symptoms. Some key points to consider when managing patients with ACS include:
- The use of anticoagulation, in addition to antiplatelet therapy, is recommended for all patients with NSTE-ACS, irrespective of initial treatment strategy 1.
- The management of AF requires rate control and adequate anticoagulation according to the 2014 AF CPG 1.
- The prophylactic use of lidocaine is not recommended, and the early administration of beta blockers has been associated with a reduction in the incidence of VF 1. The standard dosing of Nurtec is 75 mg taken orally as needed for migraine, with a maximum of one dose per 24 hours. Unlike triptans, which have clear contraindications in coronary artery disease, the cardiovascular risk profile of CGRP antagonists like Nurtec appears more favorable, but caution is still warranted in high-risk cardiac patients. It is essential to weigh the benefits and risks of using Nurtec in patients with ACS and to consider alternative treatments and close monitoring when necessary.
From the Research
Safety of Nurtec in ACS Patients
- There are no direct studies on the safety of Nurtec (rimegepant) in patients with Acute Coronary Syndrome (ACS) among the provided evidence.
- The studies focus on the management and treatment of ACS, including the use of antiplatelet and anticoagulation agents, as well as other medical therapies 2, 3, 4, 5.
- One study discusses the prehospital administration of aspirin and nitroglycerin for patients with suspected ACS, highlighting the benefits and harms of these agents in the prehospital setting 6.
- However, none of the studies mention Nurtec (rimegepant) or its safety in ACS patients, suggesting that there may be limited or no research available on this specific topic 2, 3, 6, 4, 5.
Management of ACS
- The management of ACS typically involves a combination of antiplatelet and anticoagulation agents, as well as other medical therapies such as beta blockers, statins, and angiotensin-converting enzyme inhibitors 2, 3, 4, 5.
- Early risk stratification and coronary revascularization are also key components in the management of ACS 3, 5.
- The use of dual antiplatelet therapy and anticoagulation is recommended for most patients with ACS, unless contraindicated 2, 3, 4.
Limitations of Available Evidence
- The available evidence does not provide direct information on the safety of Nurtec (rimegepant) in ACS patients.
- Further research is needed to determine the safety and efficacy of Nurtec in this patient population.