How soon can I take a second dose of Nurtec (rimegepant) after the initial dose for migraine?

How Soon Can You Take a Second Dose of Nurtec (Rimegepant) After Initial Dose for Migraine

You should not take a second dose of Nurtec (rimegepant) within 24 hours of the initial dose for migraine treatment. Nurtec is designed to be taken only once per calendar day (up to once daily) for acute migraine treatment 1.

Dosing Guidelines for Nurtec (Rimegepant)

• Nurtec is an orally disintegrating tablet (ODT) containing 75 mg of rimegepant
• Maximum dosing frequency: Once per calendar day 1
• Do not exceed one tablet in a 24-hour period
• Take at the onset of migraine pain for best results

Mechanism of Action

Nurtec works as a calcitonin gene-related peptide (CGRP) receptor antagonist, which is a different mechanism than triptans or NSAIDs 2. It blocks the CGRP pathway involved in migraine pain transmission.

What to Do If First Dose Doesn't Work

If the initial dose of Nurtec doesn't provide adequate relief:

1. Do not take a second Nurtec tablet within 24 hours
2. Consider using a rescue medication from a different class:
   • NSAIDs (ibuprofen, naproxen) can be used as rescue medications 3
   • Antiemetics (metoclopramide, domperidone) can help with associated nausea 3
   • Avoid ergot alkaloids, opioids, and barbiturates 3

Optimizing Migraine Treatment

Early Treatment is Key

• Take Nurtec early in the headache phase for better effectiveness 3
• Studies show that treating migraine when pain is mild results in significantly better pain-free response rates compared to treating when pain is moderate or severe 4

Preventing Medication Overuse Headache

• Be aware that frequent use of acute medications can lead to medication overuse headache (MOH)
• MOH is defined as headache occurring on 15 or more days per month for at least 3 months due to overuse of acute medication 3
• The threshold varies by medication type (≥15 days/month with NSAIDs; ≥10 days/month with triptans) 3

Long-term Safety Considerations

Clinical studies have shown that rimegepant:

• Is generally well-tolerated when used as directed 1
• Shows no evidence of hepatotoxicity or cardiovascular toxicity in clinical trials 2
• Common side effects include upper respiratory tract infection, nasopharyngitis, and sinusitis 1
• Has not shown signals of medication-overuse headache when used appropriately 5

When to Consider Preventive Treatment

If you're experiencing frequent migraines requiring repeated acute treatment:

• Consider preventive therapy if you have ≥2 migraine attacks per month with disability for ≥3 days/month 6
• Consider preventive therapy if you're using acute medications more than twice weekly 6
• Rimegepant can also be used as a preventive treatment when taken every other day 2

Remember that the goal of migraine management is to effectively treat attacks while minimizing the need for rescue medications and preventing medication overuse headache.