Nurtec (Rimegepant) and Breastfeeding
Nurtec (rimegepant) is safe to use during breastfeeding, with minimal transfer into breast milk and a relative infant dose of less than 1%. 1
Evidence from FDA Drug Label
The FDA-approved drug label for Nurtec ODT provides direct lactation data from a clinical study:
- A dedicated lactation study in 12 healthy breastfeeding women demonstrated that rimegepant transfer into breast milk is low 1
- The relative infant dose (RID) was less than 1% of the maternal weight-adjusted dose 1
- The milk-to-plasma ratio was 0.20, indicating minimal drug transfer 1
- These pharmacokinetic parameters support that infant exposure through breast milk is negligible 1
Clinical Interpretation
The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for rimegepant, according to the FDA label 1. Given the RID of <1%, this falls well below the generally accepted safety threshold of 10% used to determine compatibility with breastfeeding 2.
Practical Considerations
- No dosage adjustments or timing restrictions are necessary when breastfeeding while taking rimegepant 1
- The orally disintegrating tablet formulation allows for convenient dosing without impacting breastfeeding schedules 3
- No adverse effects on breastfed infants have been reported in the available data 1
- Rimegepant can be used for both acute treatment (as needed) and preventive treatment (every other day) of migraine without interrupting breastfeeding 3
Important Caveats
- While the lactation study provides reassuring data, it was conducted in only 12 women, representing a relatively small sample size 1
- Long-term safety data in breastfed infants are not yet available, though the low RID suggests minimal risk 1
- If any concerns arise about infant well-being, standard pediatric monitoring for feeding, growth, and development should be maintained 1