Can Ubrelvy (lasmiditan) be given with a triptan?

Ubrelvy (Ubrogepant) and Triptans: Safety of Co-administration

Ubrelvy (ubrogepant) should not be given concurrently with a triptan due to potential safety concerns and lack of established benefit from combination therapy. While there are no absolute contraindications to using both medications in the same day, they should be separated by at least 24 hours to minimize potential adverse effects.

Safety of Co-administration

• The FDA drug label for Ubrelvy does not explicitly prohibit concurrent use with triptans, but clinical practice guidelines recommend caution when combining different classes of migraine medications 1.

• A Phase 1 study evaluating the pharmacokinetic interaction between ubrogepant and sumatriptan found:

  • Slight alterations in ubrogepant pharmacokinetics when coadministered with sumatriptan (24% reduction in maximum plasma concentration)
  • Delayed time to maximum plasma concentration for both medications when used together
  • No significant effect on the area under the curve for either medication 2

• While this study showed no immediate safety concerns, the clinical implications of these pharmacokinetic changes remain uncertain 2.

Recommended Approach to Migraine Treatment

First-line Treatment Options:

1. NSAIDs (ibuprofen, naproxen, aspirin) alone or in combination with acetaminophen 3, 4
2. Triptans (sumatriptan, rizatriptan, etc.) as second-line therapy for those who don't respond to NSAIDs 3, 4

Alternative Options:

• Gepants (Ubrelvy/ubrogepant) for patients who:
  • Cannot take triptans due to contraindications
  • Experience inadequate efficacy with triptans
  • Have tolerability issues with triptans 5, 6

Practical Recommendations

1. Do not use Ubrelvy and a triptan simultaneously

   • Allow at least 24 hours between using these medications

2. If a patient has taken a triptan without adequate relief:

   • Wait at least 24 hours before trying Ubrelvy
   • Consider using an NSAID or acetaminophen as rescue medication instead

3. If a patient has taken Ubrelvy without adequate relief:

   • Wait at least 24 hours before using a triptan
   • Consider using an NSAID or acetaminophen as rescue medication instead

Clinical Considerations

• Ubrelvy has shown efficacy in patients who are triptan insufficient responders, making it a valuable alternative rather than an add-on therapy 5, 6.

• The Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement advises caution with triptans due to theoretical concerns regarding drug-drug interactions with commonly used medications 3.

• The American College of Physicians recommends combination therapy with NSAIDs and acetaminophen as first-line treatment for migraine, rather than combining different classes of migraine-specific medications 3, 4.

Important Precautions

• Medication overuse headache risk: Limit use of triptans to no more than 9 days per month and Ubrelvy to no more than 8 days per month to prevent medication overuse headache 4.

• Serotonin syndrome: While the risk of serotonin syndrome with triptans is low, adding another serotonergic medication could theoretically increase this risk 3.

• Cardiovascular considerations: Triptans have vasoconstrictive properties and are contraindicated in patients with certain cardiovascular conditions. Ubrelvy may be a safer alternative for these patients 3, 5.