Can Ubrelvy (ubrogepant) and Imitrex (sumatriptan) be taken together?

Can Ubrelvy and Imitrex Be Taken Together?

Yes, Ubrelvy (ubrogepant) and Imitrex (sumatriptan) can be taken together safely, with no clinically significant drug interactions or safety concerns identified. 1, 2

Evidence from FDA Drug Label

The FDA-approved prescribing information for Ubrelvy explicitly states that no significant pharmacokinetic interactions were observed when ubrogepant was administered with sumatriptan 1. This is based on formal drug-drug interaction studies that evaluated both medications together.

Clinical Trial Safety Data

Phase 1 pharmacokinetic study findings:

• When ubrogepant 100 mg and sumatriptan 100 mg were coadministered, there were minor pharmacokinetic changes that are not clinically relevant 2
• Ubrogepant's time to maximum concentration was delayed (3 hours vs 1.5 hours) and maximum concentration reduced by 24%, but the total drug exposure (AUC) remained unchanged 2
• Sumatriptan's total exposure and maximum concentration showed no significant changes when given with ubrogepant 2
• Critically, no treatment-emergent adverse events were reported with coadministration in healthy volunteers 2

Phase 3 trial data (ACHIEVE I and II):

• Among 1,938 participants with migraine, those who took ubrogepant alone versus those who took ubrogepant plus a triptan as rescue medication had similar rates of treatment-related adverse events (14.9% vs 12.8% in the 100 mg group) 2
• No new safety concerns were identified when ubrogepant was combined with triptans 2

Clinical Guideline Context

Both medications are recommended for acute migraine treatment by the 2023 VA/DoD guidelines:

• Sumatriptan receives a strong recommendation for short-term migraine treatment 3
• Ubrogepant receives a weak recommendation for short-term migraine treatment 3

The guidelines support using both drug classes as effective acute therapies, though they do not specifically address combination use 3.

Practical Considerations

Timing of administration:

• These medications can be taken together during the same migraine attack without dose adjustments 1
• Patients may use one medication initially and add the other if the first does not provide adequate relief within 2 hours 2

Common pitfalls to avoid:

• Do not confuse this combination with the contraindicated combination of triptans with MAOIs, which carries theoretical serotonin syndrome risk 4
• The slight delay in ubrogepant absorption when combined with sumatriptan does not require any clinical intervention or dose modification 2

Medication overuse considerations:

• Preclinical data suggests ubrogepant, unlike sumatriptan, does not induce latent sensitization associated with medication overuse headache 5
• This may make ubrogepant a preferable option for patients at risk of medication overuse, though both can be used acutely 5