Can Another Nurtec Be Taken After 40 Hours?
No, you should not take another dose of Nurtec (rimegepant) after 40 hours for a recurrent migraine—the FDA-approved dosing is one 75 mg orally disintegrating tablet every other day (48 hours) when used for prevention, or as needed for acute treatment with a maximum of one dose per 24 hours. 1, 2
Dosing Intervals Based on Treatment Context
For Acute Treatment of Individual Migraine Attacks
- You can take another dose after 24 hours have elapsed from the first dose, as the maximum frequency for acute treatment is one 75 mg tablet per day. 2
- At 40 hours post-dose, you are safely beyond the 24-hour minimum interval and can take another dose if experiencing a new or recurrent migraine attack. 2
- The long-term safety study in Chinese adults confirmed that rimegepant taken as needed (maximum one tablet per day) for 52 weeks demonstrated a favorable safety profile with no serious adverse events related to the medication. 2
For Preventive Treatment Regimen
- If you are using rimegepant for migraine prevention (taken every other day), you should wait the full 48 hours between doses. 1
- Taking a dose at 40 hours would be 8 hours too early for the preventive dosing schedule. 1
Critical Frequency Limitation
- Limit rimegepant use to avoid medication-overuse headache, which can develop from frequent use of acute migraine medications (more than 2 days per week for acute treatment). 3
- If you find yourself needing acute treatment more than twice weekly, initiate or optimize preventive therapy rather than increasing frequency of acute medication use. 4
- The 2024 VA/DoD guidelines note there is insufficient evidence to recommend for or against rimegepant specifically for migraine prevention, though it is suggested for short-term acute treatment. 3
When Rimegepant May Not Be Optimal
- The 2025 American College of Physicians guidelines found that rimegepant monotherapy may have lower likelihood of pain freedom and sustained pain relief compared to the combination of a triptan plus NSAID (low-certainty evidence). 3
- Consider combination therapy with sumatriptan plus naproxen for moderate to severe migraine, as this has stronger evidence (strong recommendation) than rimegepant alone (weak recommendation). 3, 4
- Rimegepant's therapeutic gain over placebo is modest, with 19.2-21.2% achieving pain freedom at 2 hours compared to 11.8% with placebo in pivotal trials. 5
Safety Considerations
- Rimegepant does not induce vasoconstriction and is not contraindicated in cardiovascular disease, unlike triptans. 5
- The most common adverse events are nausea, somnolence, and dry mouth (reported in 0.4-4.1% of patients). 6
- No evidence of hepatotoxicity or cardiovascular toxicity has been observed in clinical trials up to 52 weeks. 1, 2