Aimovig Dosing
The recommended starting dose of Aimovig (erenumab) is 70 mg subcutaneously once monthly, though patients with difficult-to-treat migraine or prior preventive treatment failures should receive 140 mg once monthly. 1
Standard Dosing Regimen
- Starting dose: 70 mg subcutaneously once monthly 1
- Alternative dose: 140 mg subcutaneously once monthly for selected patients 1
- Timing: If a dose is missed, administer as soon as possible, then resume monthly dosing from that date 1
Administration Instructions
Preparation:
- Allow Aimovig to sit at room temperature for at least 30 minutes before injection (protected from direct sunlight) 1
- Do not warm using heat sources like hot water or microwave 1
- Do not shake the product 1
- Inspect for particulate matter or discoloration; do not use if cloudy, discolored, or contains flakes 1
Injection technique:
- Administer subcutaneously in the abdomen, thigh, or upper arm 1
- Avoid areas where skin is tender, bruised, red, or hard 1
- Both autoinjector and prefilled syringe are single-dose devices that deliver the entire contents 1
When to Use 140 mg Instead of 70 mg
The 140 mg dose demonstrates numerically superior efficacy and should be strongly considered for: 2, 3
- Patients with prior preventive treatment failures (the benefit increases with more prior failures) 2, 3
- Chronic migraine patients 4
- Patients with medication overuse headache 5
- Those requiring prevention of progression to chronic migraine 2
The 2024 VA/DoD guidelines now provide a "strong for" recommendation for erenumab in both episodic and chronic migraine prevention, reflecting robust evidence from network meta-analyses 6. The evidence shows both doses reduce mean monthly migraine days and acute medication use, with the 140 mg dose showing a numerical advantage particularly in treatment-refractory populations 2, 3.
Critical Safety Considerations
Monitor for these serious complications:
- Hypertension: Postmarketing studies show increased risk of new-onset or worsening hypertension with erenumab 6, 1
- Constipation with serious complications: Can occur after first dose or later in treatment; some cases required hospitalization or surgery 1
- Hypersensitivity reactions: Including anaphylaxis and angioedema; can occur within hours to more than one week after administration 1
If serious hypersensitivity or severe constipation complications occur, discontinue Aimovig immediately. 1
Clinical Efficacy Expectations
Patients can expect:
- Onset of action within the first week 7
- Approximately 50% of patients achieve at least 50% reduction in monthly migraine days 7, 5
- Sustained efficacy with continued treatment 8
- Reduction in acute headache medication use 6, 5
The safety profile is generally favorable with low dropout rates in clinical trials, though constipation (up to 3%) and injection site reactions are the most common adverse events 1, 7.