Recommended Dosage and Usage of Ubrelvy (ubrogepant) for Acute Migraine Treatment
The recommended dose of Ubrelvy (ubrogepant) for acute treatment of migraine in adults is 50 mg or 100 mg taken orally with or without food, with a second dose permitted at least 2 hours after the initial dose if needed, and a maximum daily dose of 200 mg. 1
Dosing Guidelines
Ubrelvy is specifically indicated for the acute treatment of migraine attacks with or without aura in adults. It is not indicated for preventive treatment of migraine.
Standard Dosing:
- Initial dose: 50 mg or 100 mg orally
- Second dose (if needed): May be taken at least 2 hours after initial dose
- Maximum dose in 24 hours: 200 mg
- Safety limitation: Treating more than 8 migraines in a 30-day period has not been established 1
Modified Dosing for Special Populations:
| Condition | Initial Dose | Second Dose (if needed) |
|---|---|---|
| Moderate CYP3A4 inhibitors | 50 mg | Avoid within 24 hours |
| Weak CYP3A4 inhibitors | 50 mg | 50 mg |
| Strong CYP3A4 inducers | Avoid concomitant use | - |
| Weak & Moderate CYP3A4 inducers | 100 mg | 100 mg |
| BCRP and/or P-gp inhibitors | 50 mg | 50 mg |
| Severe hepatic impairment | 50 mg | 50 mg |
| Severe renal impairment | 50 mg | 50 mg |
| End-stage renal disease | Avoid use | - |
Place in Migraine Treatment Algorithm
According to the most recent guidelines, Ubrelvy (ubrogepant) is considered a third-line treatment option for acute migraine attacks:
- First-line: NSAIDs (acetylsalicylic acid, ibuprofen, diclofenac potassium) 2
- Second-line: Triptans 2
- Third-line: Gepants (including ubrogepant) or ditans 2
Clinical Efficacy
Clinical trials have demonstrated that ubrogepant is effective for acute migraine treatment:
- Pain freedom at 2 hours: 19.2% (50 mg) and 21.2% (100 mg) vs. 11.8% with placebo 3
- Freedom from most bothersome symptom at 2 hours: 38.9% (50 mg) vs. 27.4% with placebo 4
- Effective for treating associated symptoms such as nausea, photophobia, and phonophobia 5
Safety Profile
The most common adverse events reported with Ubrelvy include:
Unlike earlier gepants, ubrogepant has not shown evidence of hepatotoxicity at therapeutic doses 5, 6.
Important Clinical Considerations
- Ubrogepant should be taken early in the headache phase of the attack for optimal effectiveness 2
- For patients with nausea or vomiting during migraine attacks, consider adding a prokinetic antiemetic such as domperidone or metoclopramide 2
- Ubrogepant is contraindicated with concomitant use of strong CYP3A4 inhibitors and in patients with history of serious hypersensitivity to ubrogepant 1
- Long-term safety data from a 52-week extension trial showed that intermittent use of ubrogepant was well-tolerated 6
Practical Recommendations
- Ubrogepant may be particularly useful for patients who have contraindications to triptans or who have not responded adequately to NSAIDs and triptans 2
- Consider ubrogepant for patients with cardiovascular contraindications to triptans
- Counsel patients about the risk of medication overuse headache if acute medications are used too frequently (≥10 days per month for triptans; ≥15 days per month for NSAIDs) 2
- Advise patients to begin treatment as early as possible in the migraine attack for best results 2
Remember that if episodic migraine occurs frequently or if acute treatment does not provide adequate response, preventive medications may be warranted, as Ubrelvy is not indicated for migraine prevention 2, 1.