What are the contraindications to Nurtec (rimegepant)?

Contraindications to Nurtec (Rimegepant)

Nurtec ODT (rimegepant) is contraindicated only in patients with a history of hypersensitivity reaction to rimegepant, Nurtec ODT, or any of its components. 1

Detailed Information on Contraindications

• Hypersensitivity reactions to rimegepant, Nurtec ODT, or any of its components represent the only absolute contraindication to this medication 1
• Delayed serious hypersensitivity reactions have been reported in clinical trials, which can occur days after administration 1
• If a hypersensitivity reaction occurs, Nurtec ODT should be discontinued immediately and appropriate therapy initiated 1

Special Populations and Precautions (Not Contraindications)

Hepatic Impairment

• Rimegepant is not recommended for use in patients with severe hepatic impairment due to significantly increased drug exposure 2
  • Total systemic exposure increases 2.0-fold and unbound exposure increases 3.9-fold in severe hepatic impairment 2
  • Mild and moderate hepatic impairment result in less significant increases in exposure (<20% and ≤65%, respectively) 2

Drug Interactions (Requiring Dosing Adjustments)

• Avoid concomitant administration with strong inhibitors of CYP3A4 1
• Avoid another dose of Nurtec ODT within 48 hours when administered with:
  • Moderate inhibitors of CYP3A4 1
  • Potent inhibitors of P-glycoprotein (P-gp) 1, 3
• Avoid concomitant administration with strong or moderate inducers of CYP3A, which may lead to loss of efficacy 1

Cardiovascular Considerations

• Unlike triptans and ergot alkaloids, rimegepant does not have vasoconstrictive properties 4, 5
• This makes rimegepant potentially safer in patients with cardiovascular risk factors compared to triptans 4, 5, 6
• However, clinicians should remain vigilant about potential long-term effects of CGRP blockade, especially during ischemic events, as CGRP is a vital rescue molecule during ischemia 5

Clinical Pearls

• Nurtec ODT is approved for both acute treatment of migraine and preventive treatment of episodic migraine in adults 1, 7
• The VA/DoD clinical practice guidelines suggest rimegepant for the short-term treatment of migraine (weak for recommendation) 4
• There is insufficient evidence to recommend for or against rimegepant for the prevention of episodic migraine according to VA/DoD guidelines 4
• Rimegepant is generally well tolerated with no evidence of hepatotoxicity or cardiovascular toxicity in clinical trials 7
• The most common adverse reaction in clinical trials was nausea (2% vs 0.4% with placebo) 1

Monitoring Recommendations

• Monitor for signs of hypersensitivity reactions, including dyspnea and rash, which occurred in less than 1% of patients in clinical trials 1
• Be aware that hypersensitivity reactions can occur days after administration 1
• No specific laboratory monitoring is required for patients taking Nurtec ODT 1, 7