Protocol for Transferring from Ubrelvy (Ubrogepant) to Nurtec (Rimegepant)
When transferring a patient from Ubrelvy (ubrogepant) to Nurtec (rimegepant), no washout period is required as both are CGRP receptor antagonists with similar mechanisms of action but different dosing schedules.
Rationale for Transfer
Both medications are calcitonin gene-related peptide (CGRP) receptor antagonists used for acute migraine treatment, but with key differences:
- Ubrelvy (ubrogepant): Approved only for acute treatment
- Nurtec (rimegepant): Approved for both acute treatment and prevention of episodic migraine 1
Transfer Protocol
Step 1: Assess Current Treatment Response
- Evaluate effectiveness of current Ubrelvy treatment
- Document frequency of use and any side effects
- Confirm patient is not overusing acute medications (≤10 days/month) 2
Step 2: Discontinuation of Ubrelvy
- No washout period required between medications
- Simply stop Ubrelvy and start Nurtec at next migraine attack or preventive dose
Step 3: Initiate Nurtec Based on Treatment Goal
For Acute Treatment Only:
- Prescribe Nurtec ODT 75mg to be taken at onset of migraine
- Maximum: 75mg once per 24-hour period
- Limit to ≤10 days per month to prevent medication overuse headache 2
For Preventive Treatment:
- Prescribe Nurtec ODT 75mg every other day
- Note: There is insufficient evidence to make a strong recommendation for rimegepant for prevention of episodic migraine 3
Step 4: Patient Education
- Instruct on proper administration of orally disintegrating tablet:
- Place on or under tongue
- Allow to dissolve; no water needed
- Can be taken with or without food
- Explain expected efficacy (pain freedom and relief from most bothersome symptoms within 2 hours) 4
- Review potential side effects (most common: nausea, though generally well-tolerated) 1
Monitoring and Follow-up
- Schedule follow-up within 4-6 weeks to assess:
- Efficacy compared to previous treatment
- Tolerability and side effects
- Need for dose adjustments or additional treatments
- For preventive use, evaluate for 50% reduction in monthly migraine days 2
Important Considerations
- Both medications have similar safety profiles with no evidence of hepatotoxicity or cardiovascular toxicity in clinical trials 1
- Nurtec offers the convenience of an orally disintegrating tablet formulation 1
- Benefit-risk profiles favor rimegepant for sustained pain freedom (NNT 7) compared to ubrogepant (NNT varies by dose) 4
- Neither medication requires cardiovascular precautions that are necessary with triptans 5
Caution
- Avoid combining with strong CYP3A4 inhibitors
- Use caution in patients with severe hepatic or renal impairment
- Document any adverse events during the transition period
This protocol provides a straightforward approach to transitioning between these similar but distinct CGRP antagonists while maintaining effective migraine management.