What is the proper dosing regimen for Nurtec (rimegepant) when prescribing it as needed for acute migraine treatment?

Nurtec (Rimegepant) Dosing for Acute Migraine Treatment

For acute treatment of migraine, Nurtec ODT (rimegepant) should be prescribed as a single 75 mg orally disintegrating tablet taken as needed, with a maximum of one dose (75 mg) in a 24-hour period. 1

Proper Dosing Regimen

• The recommended dose is 75 mg taken orally as needed for migraine attacks 1
• Do not exceed 75 mg in a 24-hour period (maximum one dose per day) 1
• The safety of using more than 18 doses in a 30-day period has not been established 1

Administration Instructions

• Use dry hands when opening the blister pack 1
• Peel back the foil covering and gently remove the orally disintegrating tablet (do not push through foil) 1
• Place the tablet on or under the tongue immediately after opening the blister 1
• The tablet will disintegrate in saliva without requiring additional liquid 1
• Take immediately after opening; do not store outside the blister pack 1

Drug Interactions and Precautions

• Avoid concomitant administration with strong CYP3A4 inhibitors 1
• When used with moderate CYP3A4 inhibitors, avoid another dose of Nurtec within 48 hours 1
• Avoid concomitant use with strong or moderate CYP3A inducers, which may reduce efficacy 1
• With potent P-gp inhibitors, avoid another dose of Nurtec within 48 hours 1

Clinical Considerations

• Nurtec is the first CGRP receptor antagonist approved for both acute treatment and prevention of migraine 2
• For acute treatment, Nurtec has demonstrated efficacy in relieving pain and most bothersome migraine symptoms at 2 hours post-dose 3
• The orally disintegrating tablet formulation offers convenience and potentially faster response compared to conventional tablets 2
• Nurtec is generally well tolerated with nausea being the most common adverse reaction (reported in ≥1% of patients) 1

Special Populations

• Avoid use in patients with severe hepatic impairment (Child-Pugh C) as drug exposures are significantly higher in these patients 1
• Hypersensitivity reactions including dyspnea and rash have occurred; discontinue if a serious reaction occurs 1

Alternative Use Cases

• While this answer focuses on acute treatment, note that Nurtec is also approved for preventive treatment of episodic migraine at a dose of 75 mg taken every other day 1
• Rimegepant has shown efficacy in patients with insufficient response to triptans, making it a valuable option for those who don't respond well to or cannot tolerate triptans 4

Long-term Safety

• Long-term safety studies (up to 52 weeks) have shown that rimegepant is generally well tolerated with no evidence of hepatotoxicity or cardiovascular toxicity 5
• The most common adverse events in long-term use include upper respiratory tract infection, nasopharyngitis, and sinusitis 5