What is the recommended dosage and usage of Emgality (galcanezumab) for migraine prevention?

Recommended Dosage and Usage of Emgality (Galcanezumab) for Migraine Prevention

For migraine prevention in adults, Emgality (galcanezumab) is administered as a 240 mg loading dose (two consecutive 120 mg subcutaneous injections) initially, followed by 120 mg monthly subcutaneous injections. 1

Administration Details

• Route: Subcutaneous injection only
• Sites: Abdomen, thigh, back of upper arm, or buttocks
• Administration schedule:
  • First dose: 240 mg (two 120 mg injections) as loading dose
  • Subsequent doses: 120 mg once monthly

Proper Administration Technique

• Allow Emgality to sit at room temperature for 30 minutes before administration
• Do not warm using heat sources like hot water or microwave
• Do not shake the product
• Inspect visually for particulate matter or discoloration before use
• Do not use if cloudy or contains visible particles
• Avoid injecting into areas where skin is tender, bruised, red, or hard 1

Clinical Efficacy

Emgality has demonstrated significant efficacy in reducing monthly migraine headache days:

• In clinical trials, galcanezumab reduced monthly migraine headache days by 4.3 days compared to 2.3 days with placebo 2
• Onset of effect begins within the first day after injection 3
• Maintenance of effect continues throughout the treatment period 3
• Upon discontinuation, effect gradually diminishes without rebound headache 3

Position in Treatment Algorithm

According to current guidelines, CGRP monoclonal antibodies like Emgality are recommended:

• As third-line medications for migraine prevention in Europe, after failure of other preventive drugs 4
• As first-line preventive treatment for patients with high-frequency episodic migraines according to the American Academy of Neurology 5

First-line preventive options generally include:

• Beta blockers without intrinsic sympathomimetic activity (atenolol, bisoprolol, metoprolol, propranolol)
• Topiramate
• Candesartan 4

Second-line preventive options include:

• Flunarizine
• Amitriptyline
• Sodium valproate (contraindicated in women of childbearing potential) 4

Treatment Evaluation

• Assess efficacy of CGRP monoclonal antibodies like Emgality after 3-6 months of treatment 4
• Treatment success is typically defined as ≥50% reduction in monthly migraine days 5
• Consider pausing preventive treatment after 6-12 months of successful therapy to determine if continued treatment is necessary 4

Safety Considerations

• Contraindicated in patients with serious hypersensitivity to galcanezumab or any excipients 1
• Most common adverse events include injection site reactions (pain, pruritus, erythema) 2
• Hypersensitivity reactions including dyspnea, urticaria, and rash have been reported 1
• Cases of anaphylaxis and angioedema have been reported in the postmarketing setting 1
• If serious hypersensitivity reaction occurs, discontinue Emgality and initiate appropriate therapy 1

Special Populations

For episodic cluster headache (separate indication):

• Dosage is 300 mg (three consecutive 100 mg injections) at the onset of the cluster period
• Continue monthly until the end of the cluster period 1

Practical Considerations

• If a dose is missed, administer as soon as possible and reschedule monthly from the date of the last dose 1
• Protect from direct sunlight 1
• Emgality is available as 120 mg/mL single-dose prefilled pens or syringes, and 100 mg/mL single-dose prefilled syringes 1