Rimegepant Dosage and Usage for Treating Migraine Attacks
The recommended dosage of rimegepant for acute treatment of migraine is a single 75 mg orally disintegrating tablet taken as needed, with no more than one dose in a 24-hour period. 1
Placement in Migraine Treatment Algorithm
First-Line Therapy
- NSAIDs, acetaminophen, or combination of NSAID and acetaminophen are recommended as first-line therapy for most migraine attacks 2
- Specific NSAIDs with strong evidence include aspirin, ibuprofen, and diclofenac potassium 2
Second-Line Therapy
- Triptans should be offered when over-the-counter analgesics provide inadequate relief 2
- Consider adding a triptan to an NSAID or acetaminophen when patients use an adequate dose but still don't achieve sufficient pain relief 2
Third-Line Therapy (Where Rimegepant Fits)
- Rimegepant (a CGRP antagonist-gepant) should be considered for moderate to severe acute episodic migraine in adults who do not tolerate or have inadequate response to combination therapy of a triptan and an NSAID/acetaminophen 2
- Rimegepant is one of the few gepants approved for acute migraine treatment 2
Specific Dosing Information for Rimegepant
Acute Treatment
- Dosage: 75 mg orally disintegrating tablet 1
- Frequency: As needed for migraine attacks 1
- Maximum: No more than one dose in a 24-hour period 1
- Administration: Place tablet on or under the tongue; no need for water 1
Preventive Treatment
- Rimegepant can also be used for preventive treatment of episodic migraine at a dosage of 75 mg every other day 2, 3
- When used for prevention, rimegepant has shown efficacy in reducing monthly migraine days compared to placebo 3
Clinical Efficacy
- In clinical trials, rimegepant demonstrated superior efficacy to placebo for:
- Efficacy has been demonstrated across multiple populations including in the US, China, and South Korea 4, 6
Safety Considerations
Contraindications
- Hypersensitivity to rimegepant or any components of NURTEC ODT 1
Warnings and Precautions
- Hypersensitivity reactions including dyspnea and rash have occurred 1
- Delayed serious hypersensitivity has been reported; discontinue if hypersensitivity occurs 1
Drug Interactions
- Avoid concomitant use with strong CYP3A4 inhibitors 1
- With moderate CYP3A4 inhibitors, avoid another dose of rimegepant within 48 hours 1
- Avoid concomitant use with strong or moderate CYP3A inducers 1
- With P-gp inhibitors, avoid another dose of rimegepant within 48 hours 1
Common Adverse Effects
- Nausea (2-2.7% vs 0.4-0.8% with placebo) 1
- Abdominal pain/dyspepsia (2.4% vs 0.8% with placebo) when used for prevention 1
Special Populations
- Pregnancy: There is a pregnancy exposure registry; limited data on developmental risk 1
- Can be used concomitantly with CGRP monoclonal antibodies with no identified safety issues 7
Clinical Pearls
- Begin treatment as soon as possible after migraine onset for optimal efficacy 2
- Rimegepant may be particularly useful for patients who cannot take triptans due to contraindications or side effects 2
- Be aware of medication overuse headache risk; threshold varies by treatment type 2
- When treating patients with nausea/vomiting, consider adding an antiemetic 2