From the Guidelines
Nurtec (rimegepant) can be a good alternative to Sumatriptan (Imigran) for acute migraine treatment, particularly for patients who don't respond well to triptans or experience significant side effects from them. According to the most recent guidelines from the American College of Physicians 1, CGRP antagonists like rimegepant are considered effective options for treating 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.
Some key points to consider when choosing between Nurtec and Sumatriptan include:
- Mechanism of action: Nurtec blocks calcitonin gene-related peptide (CGRP) receptors, preventing the inflammatory cascade that contributes to migraine pain without causing vasoconstriction, whereas Sumatriptan works primarily as a serotonin receptor agonist causing blood vessel constriction 1.
- Safety profile: Nurtec may be safer for patients with cardiovascular risk factors who may be contraindicated for triptans 1.
- Efficacy: Both Nurtec and Sumatriptan are effective for acute migraine treatment, but individual response may vary 1.
- Side effects: Nurtec generally has mild side effects, including nausea and stomach pain, while Sumatriptan can cause more severe side effects, such as chest pain and stroke 1.
It's essential to consult a healthcare provider before switching medications, as individual response to migraine treatments varies considerably. The provider can help determine the best course of treatment based on the patient's medical history, preferences, and response to previous treatments 1.
From the FDA Drug Label
Other Drugs: No significant pharmacokinetic interactions were observed when rimegepant was concomitantly administered with oral contraceptives (norelgestromin, ethinyl estradiol), midazolam (a sensitive CYP3A4 substrate), metformin (a MATE1 substrate), or sumatriptan [see Clinical Pharmacology (12.2)].
Nurtec (rimegepant) can be considered as an alternative to Sumatriptan (Imigran) for acute migraine treatment, as there are no significant pharmacokinetic interactions between rimegepant and sumatriptan. However, the decision to use Nurtec as an alternative should be made on a case-by-case basis, considering the individual patient's medical history and response to treatment. 2
From the Research
Comparison of Nurtec and Sumatriptan
- 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.
- Sumatriptan (Imigran) is a selective 5-HT(1B/1D) receptor agonist for the acute treatment of migraine.
- Studies have shown that rimegepant is effective for the acute treatment of migraine in adults with a history of insufficient response to 1 or ≥2 triptans and in current triptan users 4.
- A systematic review and meta-analysis found that most triptans were associated with higher odds ratios for pain freedom and pain relief at 2 hours compared with rimegepant, but rimegepant was associated with a lower risk of adverse events 5.
- Rimegepant orally disintegrating tablet (ODT) is a novel mechanism of action for the treatment of acute migraine, with a convenient dosage form and limited adverse effect profile 6.
Efficacy and Safety
- Rimegepant has been shown to significantly improve freedom from pain at 2 hours after the dose and freedom from the most bothersome symptom 2 hours postdose 3, 6.
- Adverse effects of rimegepant include nausea, urinary tract infection, and dizziness 6.
- Sumatriptan has been compared to rizatriptan, another 5-HT(1B/1D) receptor agonist, and found to have a slower onset of action and a lower overall response rate 7.
Alternative Treatment Option
- Rimegepant may be a good alternative to sumatriptan for acute migraine treatment, especially for patients who experience inadequate relief from triptans or have contraindications to triptans 4, 6.
- The lack of cardiovascular risks associated with rimegepant may offer an advantage over triptans, which are contraindicated in patients with coronary artery disease 5.