What is Ubrelvy (ubrogepant)?

Ubrelvy (Ubrogepant): An Oral CGRP Receptor Antagonist for Acute Migraine Treatment

Ubrelvy (ubrogepant) is an oral calcitonin gene-related peptide (CGRP) receptor antagonist FDA-approved for the acute treatment of migraine attacks with or without aura in adults. 1

Mechanism and Classification

• Ubrogepant works by antagonizing CGRP receptors, which play a key role in migraine pathophysiology 1
• It belongs to the "gepant" class of medications, specifically designed for migraine treatment 1
• Unlike triptans, ubrogepant does not cause vasoconstriction, potentially making it suitable for patients with cardiovascular contraindications 2, 3

Clinical Indications and Efficacy

• Ubrogepant is indicated only for acute treatment of migraine attacks and is not approved for preventive therapy 1
• The 2023 VA/DoD Clinical Practice Guideline for Headache Management suggests ubrogepant for the short-term treatment of migraine (weak recommendation) 4
• Clinical trials demonstrated that ubrogepant is effective for:
  • Pain freedom at 2 hours (21.8% for 50mg dose vs 14.3% for placebo) 2
  • Relief from most bothersome migraine-associated symptom at 2 hours (38.9% for 50mg dose vs 27.4% for placebo) 2
  • Reduction in photophobia and phonophobia 1

Dosing and Administration

• Available in 50mg and 100mg oral tablets 1
• Can be taken with or without food 1
• Most patients can take a second tablet 2 hours after the first tablet if needed 1
• Important limitation: It is not known if it's safe to take Ubrelvy for more than 8 migraine headaches in 30 days 1

Drug Interactions

• Contraindicated with strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin, itraconazole) 1
• Dose adjustments needed with moderate CYP3A4 inhibitors including:
  • Verapamil, cyclosporine, ciprofloxacin, fluconazole, fluvoxamine 1
  • Second dose should not be taken within 24 hours when using these medications or consuming grapefruit juice 1

Safety Profile and Adverse Effects

• Most common adverse events (occurring in ≥2% of patients):
  • Nausea (2.0-2.5%)
  • Dizziness (1.4-2.1%)
  • Somnolence and dry mouth may also occur 3
• Allergic reactions can occur, though most are not serious and occur within hours of taking the medication 1
• Recent research shows that ubrogepant can be safely used concomitantly with atogepant (a CGRP antagonist for migraine prevention) 5

Emerging Applications

• Recent research demonstrates efficacy when administered during the migraine prodrome phase:
  • Significantly prevents onset of moderate or severe headache 6
  • Improves ability to function normally over 24 hours 7
  • Reduces activity limitations and increases patient satisfaction 7

Comparison to Other Migraine Treatments

• The VA/DoD guidelines strongly recommend triptans (eletriptan, frovatriptan, rizatriptan, sumatriptan, zolmitriptan) and aspirin-acetaminophen-caffeine combination as first-line acute treatments 4
• Ubrogepant and rimegepant (another gepant) have weaker recommendations but may be appropriate alternatives for patients who cannot tolerate or have contraindications to first-line treatments 4

Important Clinical Considerations

• Patients should track their headaches and medication use to monitor effectiveness and stay within the recommended monthly limit 1
• Pregnancy registry exists for women who take Ubrelvy during pregnancy, as effects on unborn babies are unknown 1
• Not known if Ubrelvy passes into breast milk 1

Remember to document headache characteristics before and after treatment to assess response and guide future management decisions.