Is Nurtec (rimegepant) safe to use during pregnancy?

Nurtec (Rimegepant) in Pregnancy

Nurtec (rimegepant) should not be used during pregnancy due to insufficient human safety data, and safer migraine treatment alternatives with established pregnancy safety profiles should be used instead.

Evidence Base and Rationale

The available evidence regarding rimegepant use in pregnancy is extremely limited:

• No formal guidelines or drug labels addressing rimegepant safety in pregnancy were identified in the current evidence base
• Only one case series exists evaluating CGRP-targeted therapies (including rimegepant) with 92 safety reports showing miscarriage and congenital anomaly rates similar to the general population, but this data is insufficient to establish safety 1
• The general principle for medication use in pregnancy requires weighing maternal benefits against fetal risks, with preference for medications with established safety profiles 2, 3

Recommended Approach During Pregnancy

For Acute Migraine Treatment:

• Use NSAIDs (particularly in second trimester) or acetaminophen as first-line non-specific therapy for mild-to-moderate migraine 4
• Consider these options before resorting to medications with limited pregnancy data 3

For Migraine Prevention:

• Avoid initiating rimegepant or other CGRP-targeted therapies during pregnancy due to inadequate safety data 1
• If a patient becomes pregnant while on rimegepant, discontinue the medication and transition to treatments with better-documented pregnancy safety profiles 2

Critical Considerations

Lack of Safety Data:

• Rimegepant is a second-generation gepant with promising efficacy but minimal human pregnancy exposure data 4
• The single available case series is insufficient to rule out teratogenic or fetotoxic effects 1

Risk-Benefit Analysis:

• While migraine can be significantly disabling, the unknown fetal risks of rimegepant outweigh potential maternal benefits when safer alternatives exist 2, 3
• Medications should only be designated as "tolerable" in pregnancy when there is no reliable evidence of teratogenic effects; rimegepant does not meet this threshold 3

Preconception Counseling:

• Women of childbearing potential taking rimegepant should receive counseling about pregnancy risks and alternative treatment options before conception 2
• Effective contraception should be discussed if continuing rimegepant therapy 5