No Clinically Significant Drug Interaction Between Nurtec and Cyclosporine Eye Drops
There is no clinically significant drug interaction between Nurtec (rimegepant) and cyclosporine ophthalmic drops, and these medications can be used together safely. The interaction study with systemic cyclosporine demonstrates minimal impact on rimegepant exposure, and topical cyclosporine eye drops have negligible systemic absorption, making any interaction clinically irrelevant.
Evidence from FDA Drug Label
The FDA label for rimegepant provides direct evidence regarding cyclosporine interaction 1:
- A dedicated drug interaction study showed that concomitant administration of rimegepant with cyclosporine (a potent P-gp and BCRP inhibitor) resulted in only a 1.6-fold increase in rimegepant AUC and 1.4-fold increase in Cmax 1
- This magnitude of increase is not considered clinically significant and does not require dose adjustment 1
- The study evaluated systemic cyclosporine, which produces far higher blood levels than topical ophthalmic formulations 1
Why Topical Cyclosporine Eye Drops Are Even Less Concerning
Cyclosporine eye drops have extremely low systemic bioavailability, making drug interactions with oral medications virtually impossible 2:
- Blood concentrations after topical cyclosporine 2% eye drops (six drops daily) only reach the detection limit of assays, indicating negligible systemic absorption 2
- This explains the complete absence of systemic toxicity with topical cyclosporine 2
- Even with repeated dosing, systemic integration is minimal to undetectable 2
Clinical Recommendation
Patients can safely use Nurtec (rimegepant) for migraine treatment while using cyclosporine eye drops for dry eye disease or other ocular conditions without dose adjustment or special monitoring 1, 2:
- No dose modification of rimegepant is needed 1
- No additional monitoring is required beyond standard care for each medication 1, 2
- The interaction observed with systemic cyclosporine (1.6-fold increase) is already considered clinically insignificant, and topical formulations produce exponentially lower systemic exposure 1, 2
Important Context
The rimegepant drug label specifically addresses interactions with strong CYP3A4 inhibitors (which increase exposure 4-fold) and P-gp/BCRP inhibitors like cyclosporine (which increase exposure only 1.6-fold) 1. The modest 1.6-fold increase with systemic cyclosporine does not warrant dose adjustment, and topical cyclosporine produces negligible systemic levels 1, 2. This makes the theoretical interaction with eye drops clinically meaningless in real-world practice.