From the FDA Drug Label
NURTEC ODT is contraindicated in patients with a history of hypersensitivity reaction to rimegepant, NURTEC ODT, or any of its components. Delayed serious hypersensitivity has occurred [see Warnings and Precautions (5.1)]. The contraindications for Nurtec (rimegepant) are:
- A history of hypersensitivity reaction to rimegepant, NURTEC ODT, or any of its components 1 The main key point is that patients with a history of hypersensitivity reaction to rimegepant or its components should not use Nurtec ODT.
From the Research
Nurtec (rimegepant) is contraindicated in patients with a history of hypersensitivity to rimegepant or any of its components, and it should not be used concurrently with strong CYP3A4 inhibitors. The most recent and highest quality study, published in 2024 2, provides evidence on the efficacy and safety of rimegepant for the acute and preventive treatment of migraine. Key points to consider when prescribing Nurtec include:
- Hypersensitivity reactions: Patients who have had allergic reactions to rimegepant, such as rash, hives, swelling, or difficulty breathing, should not take it.
- CYP3A4 inhibitors: Nurtec should not be used concurrently with strong CYP3A4 inhibitors like ketoconazole, itraconazole, clarithromycin, or ritonavir, as these medications can significantly increase rimegepant levels in the blood, potentially leading to adverse effects.
- Hepatic and renal impairment: While not an absolute contraindication, Nurtec should be used with caution in patients with severe hepatic or renal impairment, as drug clearance may be reduced in these populations.
- Pregnancy: Pregnant women should use Nurtec only if the potential benefit justifies the potential risk to the fetus, as safety during pregnancy has not been well established. These considerations are based on the pharmacokinetics of rimegepant, which is metabolized primarily by the liver through the CYP3A4 enzyme system, and interference with this pathway can lead to drug accumulation and increased risk of side effects, as noted in a study published in 2021 3. Additionally, a review of rimegepant for the treatment of migraine, published in 2021 4, highlights the importance of considering the potential risks and benefits of rimegepant in patients with cardiovascular disease, although it is not contraindicated in these patients. Overall, the evidence suggests that Nurtec is a safe and effective treatment option for migraine, but it should be used with caution in certain patient populations, as supported by a study published in 2023 5.