NURTEC ODT (Rimegepant) 75mg for Acute Migraine Treatment
NURTEC ODT (rimegepant) 75mg is a CGRP receptor antagonist approved for acute migraine treatment, administered as a single 75mg orally disintegrating tablet at migraine onset, with a maximum of one dose per 24 hours and no more than 18 doses per 30 days. 1
Dosing and Administration
- Take 75mg orally as needed at migraine onset 1
- Maximum dose: 75mg in any 24-hour period 1
- Safety limit: No more than 18 doses in a 30-day period 1
- The orally disintegrating tablet should be placed on or under the tongue using dry hands, where it dissolves without additional liquid 1
- Do not push the tablet through foil; peel back the blister pack carefully 1
Position in Treatment Algorithm
Rimegepant represents third-line therapy for acute migraine, reserved for patients who have failed or have contraindications to both NSAIDs and all available triptans. 2
Stepped Care Approach:
First-line: NSAIDs (aspirin, ibuprofen, naproxen sodium, or diclofenac potassium) 2
Second-line: Triptans (when NSAIDs provide inadequate relief) 2
Third-line: Gepants (rimegepant, ubrogepant) or ditans (lasmiditan) 2
- Use rimegepant only after adequate trial of all available triptans (no or insufficient response in at least three consecutive attacks) or when triptans are contraindicated 2
Clinical Evidence and Efficacy
- Rimegepant demonstrated superior efficacy versus placebo for pain relief and resolution of most bothersome symptom in pivotal phase III trials 3
- Long-term safety data from 52-week studies showed favorable tolerability with no evidence of hepatotoxicity or cardiovascular toxicity 3, 4
- In Chinese adults, mean reduction of 4.4 monthly migraine days was observed during long-term treatment 4
- Treatment-emergent adverse events occurred in 57.6-66.3% of participants across triptan subgroups, with rimegepant-related AEs in only 17.7-23.2% 5
Safety Profile and Contraindications
Contraindicated in patients with history of hypersensitivity to rimegepant or any component. 1
Common Adverse Reactions:
- Nausea (most common for acute treatment) 1
- Abdominal pain/dyspepsia (preventive treatment) 1
- Upper respiratory tract infection (7.7-9.5% in long-term studies) 5
Hypersensitivity Warning:
- Delayed serious hypersensitivity reactions can occur days after administration, including dyspnea and rash 1
- If hypersensitivity occurs, discontinue immediately and initiate appropriate therapy 1
Critical Drug Interactions
Avoid concomitant use with strong CYP3A4 inhibitors entirely. 1
- With moderate CYP3A4 inhibitors: Avoid another dose within 48 hours 1
- With strong or moderate CYP3A inducers: Avoid concomitant administration (may lead to loss of efficacy) 1
- With potent P-gp inhibitors: Avoid another dose within 48 hours 1
Special Populations
Avoid use in patients with severe hepatic impairment (Child-Pugh C), as exposures are significantly higher in this population. 1
Dual Indication Advantage
- Rimegepant is the first agent approved for both acute treatment (75mg as needed) and preventive treatment (75mg every other day) of migraine 3
- For preventive use: 75mg taken orally every other day 1
- This dual capability allows seamless transition between acute and preventive strategies without medication switching 3
Patient Preference Data
- After long-term treatment, >75% of participants across all triptan subgroups (including triptan-naïve, current users, and those with triptan failures) preferred rimegepant to their previous medication 5
Critical Pitfall to Avoid
Do not allow patients to exceed 18 doses in 30 days, as this increases risk of medication-overuse headache and safety has not been established beyond this frequency. 1 If patients require more frequent acute treatment, transition to preventive therapy rather than increasing acute medication frequency 2