What is the correct prescription for Ubrelvy (Ubrogepant) for acute treatment of migraine attacks in adults?

Correct Prescription for Ubrelvy (Ubrogepant)

The recommended prescription for Ubrelvy is 50 mg or 100 mg taken orally as needed for acute migraine attacks, with the option to take a second dose at least 2 hours after the initial dose if needed, not exceeding 200 mg in a 24-hour period. 1

Dosing Guidelines

• Standard dosing:

  • Initial dose: 50 mg or 100 mg orally
  • Second dose (if needed): Take at least 2 hours after initial dose
  • Maximum daily dose: 200 mg within 24 hours

• Adjusted dosing for special populations:

  • Severe hepatic impairment: 50 mg initial dose, with option for second 50 mg dose after 2 hours
  • Severe renal impairment: 50 mg initial dose, with option for second 50 mg dose after 2 hours
  • Avoid use in patients with end-stage renal disease 1, 2

Important Contraindications

• Do not prescribe with strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin, itraconazole)
• Do not prescribe to patients with history of serious hypersensitivity to ubrogepant or any component of Ubrelvy 1

Drug Interaction Considerations

For patients taking the following medications, special dosing considerations apply:

• Moderate or weak CYP3A4 inhibitors (e.g., verapamil, fluconazole, fluvoxamine)
• CYP3A4 inducers (e.g., phenytoin, barbiturates, rifampin, St. John's Wort)
• BCRP and/or P-gp inhibitors (e.g., quinidine, carvedilol, eltrombopag)

Patients taking these medications should not take a second dose within 24 hours if they consume grapefruit or grapefruit juice 1

Clinical Efficacy

Ubrelvy has demonstrated efficacy for acute migraine treatment in clinical trials:

• 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: 38.6% (50 mg) and 37.7% (100 mg) vs. 27.8% with placebo 3
• Pain relief begins as early as 1 hour post-dose 4
• Effects can last up to 48 hours 4

Adverse Effects

The most common adverse effects (occurring in ≥2% of patients and greater than placebo):

• Nausea (up to 4.1% at 100 mg dose)
• Somnolence
• Dry mouth 1, 3

Patient Counseling Points

• Take Ubrelvy with or without food
• Document frequency of migraine attacks and medication use
• Report any hypersensitivity reactions (which can occur within minutes, hours, or days after administration)
• Inform patients that Ubrelvy is only for acute treatment, not prevention of migraine 1

Pregnancy Considerations

• Limited data on use during pregnancy
• Patients who become pregnant while taking Ubrelvy should be encouraged to enroll in the pregnancy registry (1-833-277-0206 or http://empresspregnancyregistry.com) 1

Clinical Pearls

• Ubrelvy was the first oral CGRP receptor antagonist approved for acute migraine treatment 5
• Unlike earlier gepants, Ubrelvy does not show hepatotoxicity at therapeutic doses 5
• Approximately 1 in 5 patients achieve full pain relief with a single dose 5
• Maximum plasma concentrations are achieved at 1 hour, with pharmacologically active concentrations reached within 11 minutes 4