Contraindications to Starting Nurtec (Rimegepant)
Nurtec (rimegepant) has only one absolute contraindication: a history of hypersensitivity reaction to rimegepant, Nurtec ODT, or any of its components. 1
Absolute Contraindication
- Hypersensitivity reactions including dyspnea, rash, or any allergic response to rimegepant or its components constitute the sole FDA-labeled contraindication 1
- Delayed serious hypersensitivity reactions can occur days after administration, making any prior reaction a permanent contraindication 1
- If hypersensitivity occurs, discontinue Nurtec immediately and do not rechallenge 1
Critical Precautions and Avoidance Situations
Severe Hepatic Impairment
- Rimegepant is not recommended in patients with severe hepatic impairment (Child-Pugh Class C) 2
- Systemic exposure increases 2.0-fold for total concentrations and 3.9-fold for unbound concentrations in severe hepatic impairment 2
- Mild to moderate hepatic impairment shows <65% increase in exposure and does not require dose adjustment 2
Drug Interactions Requiring Avoidance
Strong CYP3A4 inhibitors:
- Avoid concomitant administration with strong CYP3A4 inhibitors entirely 1
- Examples include ketoconazole, itraconazole, clarithromycin 1
Moderate CYP3A4 inhibitors:
- Avoid another dose of Nurtec within 48 hours when coadministered with moderate CYP3A4 inhibitors 1
Strong or moderate CYP3A inducers:
- Avoid concomitant use as these may lead to loss of efficacy 1
- Examples include rifampin, phenytoin, carbamazepine 1
Potent P-glycoprotein inhibitors:
- Avoid another dose within 48 hours when coadministered with potent P-gp inhibitors 1
- Cyclosporine and quinidine increase rimegepant exposure by 50-67% 3
Important Clinical Context
- Unlike triptans, rimegepant has no vasoconstrictive properties, making cardiovascular disease NOT a contraindication 4
- No signal of hepatotoxicity has been identified in long-term safety studies up to 52 weeks 5
- No evidence of medication-overuse headache or drug abuse potential 5
- Rimegepant is safe and well-tolerated with most adverse events being mild upper respiratory infections or nasopharyngitis 5