What is the recommended dosing for Ubrelvy (Ubrogepant) for acute migraine treatment?

Ubrelvy (Ubrogepant) Dosing for Acute Migraine Treatment

The recommended dosing for Ubrelvy (ubrogepant) is 50 mg or 100 mg taken orally with or without food, with a possible second dose at least 2 hours after the initial dose if needed, and a maximum daily dose of 200 mg. 1

Standard Dosing Protocol

Ubrelvy is FDA-approved for the acute treatment of migraine with or without aura in adults. The dosing regimen is straightforward:

• Initial dose: 50 mg or 100 mg orally
• Second dose: May be taken at least 2 hours after initial dose if needed
• Maximum daily dose: 200 mg in a 24-hour period
• Administration: Can be taken with or without food
• Usage limit: Safety of treating more than 8 migraines in a 30-day period has not been established 1

Dosage Modifications

Several situations require dosage adjustments:

Drug Interactions

• Moderate CYP3A4 inhibitors: Initial dose 50 mg, avoid second dose within 24 hours
• Weak CYP3A4 inhibitors: Initial dose 50 mg, second dose 50 mg if needed
• Strong CYP3A4 inducers: Avoid concomitant use
• Weak & Moderate CYP3A4 inducers: Initial dose 100 mg, second dose 100 mg if needed
• BCRP and/or P-gp inhibitors: Initial dose 50 mg, second dose 50 mg if needed 1

Special Populations

• Severe hepatic impairment (Child-Pugh Class C): Initial dose 50 mg, second dose 50 mg if needed
• Severe renal impairment (CLcr 15-29 mL/min): Initial dose 50 mg, second dose 50 mg if needed
• End-stage renal disease (CLcr <15 mL/min): Avoid use 1

Clinical Efficacy and Timing

Ubrelvy has demonstrated clinical efficacy with the following timeline:

• Pain relief begins to separate from placebo by 1 hour
• Absence of most bothersome symptom by 1.5 hours
• Pain freedom by 2 hours
• Effects sustained from 2-24 hours and remain separated at 48 hours 2

Contraindications

Ubrelvy is contraindicated in:

• Patients taking strong CYP3A4 inhibitors
• Patients with history of serious hypersensitivity to ubrogepant or any component of Ubrelvy 1

Important Clinical Considerations

1. Early administration: Counsel patients to begin treatment as soon as possible after migraine onset for optimal efficacy 3

2. Combination therapy: Consider combining Ubrelvy with NSAIDs or acetaminophen for improved efficacy 3

3. Prodrome treatment: Recent evidence shows Ubrelvy is effective when administered during the prodrome phase of migraine 4

4. Medication overuse headache: Warn patients about the risk of medication overuse headache, which can occur with frequent use of acute migraine medications 3

5. Safety profile: The most common adverse events are nausea (up to 4.1%), somnolence, and dry mouth, with higher incidence in the 100 mg dose group 5

6. Long-term safety: Long-term intermittent use of Ubrelvy 50 mg and 100 mg has been shown to be safe and well-tolerated over a 1-year period 6

Pitfalls to Avoid

• Not considering drug interactions: Carefully assess concomitant medications that may affect CYP3A4 metabolism
• Exceeding maximum dosage: Never exceed 200 mg in 24 hours
• Overuse: Avoid treating more than 8 migraines per month with Ubrelvy
• Inappropriate use: Ubrelvy is not indicated for preventive treatment of migraine 1, 7
• Using in contraindicated populations: Avoid use in patients with end-stage renal disease or those taking strong CYP3A4 inhibitors 1

Ubrelvy represents a newer class of migraine treatment (CGRP receptor antagonist) that offers an alternative for patients who cannot tolerate or do not respond adequately to traditional migraine treatments such as triptans or NSAIDs.