Using Nurtec (Rimegepant) in a 17-Year-Old
Nurtec (rimegepant) is NOT FDA-approved for use in patients under 18 years of age, and current guidelines do not support its use in adolescents aged 17 or younger. 1
Age-Based Treatment Recommendations
For This 17-Year-Old Patient
First-line acute treatment should be ibuprofen, as recommended by the American Academy of Neurology for pediatric migraine 2
For moderate-severe migraines, consider:
Add antiemetics such as metoclopramide or prochlorperazine if nausea or vomiting accompanies the migraine 2
Why Rimegepant Is Not Appropriate
Rimegepant is approved only for adults for both acute treatment and preventive treatment of migraine 1, 3
All pivotal phase III trials establishing rimegepant's efficacy enrolled participants aged ≥18 years 4, 5
There is no published safety or efficacy data for rimegepant in pediatric or adolescent populations under age 18 1, 3
Clinical Pitfalls to Avoid
Do not use rimegepant off-label in adolescents when evidence-based alternatives (ibuprofen, triptans) are available and guideline-recommended 2
Avoid ketorolac in patients with aspirin/NSAID-induced asthma, pregnancy, or cerebrovascular hemorrhage 2
Limit ketorolac treatment duration to no more than five days to minimize adverse effects including gastrointestinal upset and renal toxicity 2
When the Patient Turns 18
Once the patient reaches 18 years of age, rimegepant becomes an appropriate option if they do not tolerate or have inadequate response to NSAIDs or triptans 6
The American College of Physicians recommends gepants like rimegepant as third-line therapy after NSAIDs (first-line) and triptans (second-line) 6
Rimegepant 75 mg orally disintegrating tablet has demonstrated superiority over placebo for pain relief at 2 hours (56% vs 33%) and pain freedom at 2 hours in adults 4, 5