Is it safe to take Ubrelvy (Ubrogepant) and Eletriptan (Eletriptan) together?

Ubrelvy and Eletriptan Should Not Be Taken Together

Taking Ubrelvy (ubrogepant) and eletriptan together is not recommended due to potential safety concerns and lack of established safety data for concurrent use.

Mechanism of Action and Drug Class Considerations

• Ubrelvy (ubrogepant): A calcitonin gene-related peptide (CGRP) receptor antagonist (gepant) approved for acute migraine treatment 1
• Eletriptan: A triptan medication (5-HT1B/1D receptor agonist) also used for acute migraine treatment 1

Safety Considerations for Combined Use

Pharmacokinetic Interactions

While a Phase 1 study specifically examined ubrogepant with sumatriptan (not eletriptan), the findings are relevant:

• When ubrogepant was coadministered with sumatriptan, ubrogepant's:

  • Time to maximum concentration was delayed (3 hours vs 1.5 hours)
  • Maximum plasma concentration was reduced by 24% 2

• Sumatriptan's time to maximum concentration was also delayed (3 hours vs 1 hour) when coadministered with ubrogepant 2

These pharmacokinetic alterations, while possibly minimal in clinical relevance, indicate drug interaction potential between these medication classes.

Guideline Recommendations

The Mayo Clinic Proceedings consensus statement on perioperative medication management specifically advises:

• Triptans (including eletriptan) should be held on the day of surgical procedures due to theoretical concerns regarding drug-drug interactions 1
• This caution reflects the potential for interactions between triptans and other medications

Alternative Approach

The CDC Clinical Practice Guideline for migraine treatment states:

• For episodic migraine, triptans, NSAIDs, combined triptans with NSAIDs, antiemetics, dihydroergotamine, and gepants (like ubrogepant) are established acute treatments 1
• These medications are typically used individually rather than in combination

Evidence from Clinical Trials

• In the Phase 3 ACHIEVE trials for ubrogepant, only a small subset of participants (39 out of 1938) used both ubrogepant and a triptan (as rescue medication, not simultaneously) 2
• While no new safety concerns were identified in this limited sample, this does not constitute robust evidence for routine combined use 2

Specific Concerns with Combined Use

1. Potential for additive side effects: Both medications can cause nausea, dizziness, and somnolence 3, 4

2. Cardiovascular considerations:

   • Triptans have vasoconstrictive effects and are contraindicated in patients with cardiovascular disease 5
   • While gepants like ubrogepant are believed to be non-vasoconstrictive, the combined cardiovascular effects are not well studied 1

3. Serotonin syndrome risk:

   • Triptans have theoretical risk of serotonin syndrome when combined with other serotonergic medications 1
   • The risk of adding ubrogepant to this profile is unknown

Recommended Approach for Migraine Treatment

1. Choose one first-line agent:

   • Either ubrogepant OR eletriptan (not both simultaneously)
   • Start with medication at recommended dosage:
     • Ubrogepant: 50-100 mg as a single dose 4
     • Eletriptan: 40-80 mg as a single dose 5

2. If initial treatment fails:

   • Wait at least 24 hours before switching to the other medication
   • Do not take both medications within the same 24-hour period

3. For frequent migraines:

   • Consider preventive therapy if experiencing ≥7 migraine days per month 5
   • Limit use of any acute medication to avoid medication overuse headache:
     • Triptans: No more than 9 days per month 5
     • All acute medications: No more than 14-15 days per month 5

Bottom Line

Until more safety data becomes available specifically addressing the concurrent use of gepants and triptans, patients should use either ubrogepant OR eletriptan for a single migraine attack, but not both medications together.