Ubrogepant Dosage for Migraine Treatment
The recommended dosage of ubrogepant (Ubrelvy) for acute migraine treatment is 50 mg or 100 mg taken orally, with a second dose possible after at least 2 hours if needed, and a maximum daily dose of 200 mg. 1
Dosing Recommendations
- Ubrogepant is available in 50 mg and 100 mg oral tablets for the acute treatment of migraine with or without aura in adults 1
- Initial dose can be 50 mg or 100 mg taken orally with or without food 1
- If needed, a second dose may be administered at least 2 hours after the initial dose 1
- Maximum dose in a 24-hour period should not exceed 200 mg 1
- The safety of treating more than 8 migraines in a 30-day period has not been established 1
Dosage Modifications
For Drug Interactions
- With moderate CYP3A4 inhibitors: Initial dose of 50 mg, avoid second dose within 24 hours 1
- With weak CYP3A4 inhibitors: Initial dose of 50 mg, second dose of 50 mg if needed 1
- With strong CYP3A4 inhibitors: Avoid concomitant use (contraindicated) 1
- With weak & moderate CYP3A4 inducers: 100 mg for both initial and second dose 1
- With BCRP and/or P-gp inhibitors: 50 mg for both initial and second dose 1
For Special Populations
- Severe hepatic impairment (Child-Pugh Class C): 50 mg for both initial and second dose 1
- Severe renal impairment (CLcr 15-29 mL/min): 50 mg for both initial and second dose 1
- End-stage renal disease (CLcr <15 mL/min): Avoid use 1
Clinical Efficacy
- In phase III clinical trials (ACHIEVE I and II), ubrogepant demonstrated effectiveness for acute migraine attacks 2
- At 2 hours post-dose, pain freedom was reported by 21.8% of participants taking 50 mg and 14.3% taking placebo in the ACHIEVE II trial 3
- Ubrogepant also improved patient-reported functional disability and satisfaction compared to placebo 4
Place in Therapy
- Ubrogepant is considered a third-line medication for acute migraine treatment 5
- It should be considered for patients who do not tolerate or have inadequate response to combination therapy of a triptan and an NSAID or acetaminophen 5
- As a CGRP antagonist (gepant), ubrogepant offers an alternative mechanism of action compared to triptans 2
Safety Considerations
- The most common adverse events within 48 hours include nausea (2.0%), dizziness (1.4%), and somnolence 3, 6
- Hypersensitivity reactions, including anaphylaxis, dyspnea, and facial or throat edema, have been reported 1
- Unlike earlier gepants, ubrogepant is free from hepatotoxicity at therapeutic doses 2
- Concomitant use with atogepant (a CGRP antagonist for migraine prevention) appears safe and well-tolerated 7
Important Clinical Considerations
- Begin treatment as soon as possible after migraine onset for optimal efficacy 5
- Ubrogepant can be taken with or without food 1
- For patients with significant nausea or vomiting during migraine attacks, consider adding an antiemetic 5
- Monitor for medication overuse headache, which can occur with frequent use of acute migraine treatments 5