Can you take Nurtec (rimegepant) and Qulipta (atogepant) at the same time?

Concurrent Use of Nurtec (Rimegepant) and Qulipta (Atogepant)

You should not take Nurtec (rimegepant) and Qulipta (atogepant) at the same time as both medications are CGRP receptor antagonists (gepants) and there is no evidence supporting the safety or efficacy of this combination. 1

Mechanism and Concerns

Both medications work through the same mechanism:

• Nurtec (rimegepant) is a CGRP receptor antagonist approved for both acute treatment and prevention of migraine 2
• Qulipta (atogepant) is also a CGRP receptor antagonist approved for preventive treatment of migraine
• Using two medications with the same mechanism simultaneously could potentially:
  • Increase risk of adverse effects
  • Provide no additional benefit over using just one
  • Lead to unnecessary medication costs

Evidence-Based Approach to Migraine Management

The American College of Physicians clinical guideline for migraine treatment recommends a stepwise approach 1:

1. First-line acute treatment:

   • NSAIDs, acetaminophen, or combination of NSAID and acetaminophen
   • If inadequate response, add a triptan to an NSAID or acetaminophen

2. For patients who don't respond to or tolerate first-line options:

   • Consider CGRP antagonists (gepants) like rimegepant (Nurtec)
   • The guideline specifically mentions rimegepant, ubrogepant, or zavegepant as options

3. For prevention (if frequent episodes or inadequate acute treatment response):

   • Consider preventive medications
   • Atogepant (Qulipta) would fall into this category

Appropriate Use of CGRP Antagonists

For Acute Treatment:

• Rimegepant (Nurtec) is FDA-approved for acute treatment of migraine 2
• Take as needed when migraine occurs
• Do not exceed recommended dosing frequency

For Prevention:

• Both rimegepant (Nurtec) and atogepant (Qulipta) are approved for prevention
• Choose ONE preventive agent based on:
  • Patient preference
  • Insurance coverage
  • Side effect profile
  • Dosing schedule

Safety Considerations

While there is a case report showing that rimegepant can be safely used with CGRP monoclonal antibodies (like erenumab, fremanezumab, or galcanezumab) 3, there is no published evidence supporting the concurrent use of two oral CGRP receptor antagonists like rimegepant and atogepant.

Potential concerns include:

• Risk of Raynaud's phenomenon has been reported with CGRP receptor antagonists 4
• Additive side effects such as nausea, which is already common with these medications 2, 5
• No established dosing guidelines for combination therapy

Bottom Line

Choose either Nurtec (rimegepant) OR Qulipta (atogepant) based on whether you need:

• Acute treatment only
• Preventive treatment only
• Both acute and preventive treatment (in which case Nurtec alone might be preferable since it's approved for both indications) 2

If one medication doesn't provide adequate relief, consult your healthcare provider about switching to the other rather than taking both simultaneously.