Can a patient with a history of depression, currently taking Paxil (paroxetine), take Ubrelvy (ubrogepant) for migraines?

Can a Patient Taking Paxil (Paroxetine) Take Ubrelvy (Ubrogepant) for Migraines?

Yes, a patient taking Paxil (paroxetine) can safely take Ubrelvy (ubrogepant) for acute migraine treatment, as there are no contraindications or significant drug interactions between these medications. 1

Drug Interaction Assessment

• The FDA label for Ubrelvy does not list SSRIs, including paroxetine (Paxil), as contraindicated medications or drugs requiring dose adjustment. 1
• The only absolute contraindications for Ubrelvy are strong CYP3A4 inhibitors (ketoconazole, clarithromycin, itraconazole), and paroxetine is not a strong CYP3A4 inhibitor. 1
• Moderate CYP3A4 inhibitors that require caution with Ubrelvy include verapamil, cyclosporine, ciprofloxacin, fluconazole, and fluvoxamine—paroxetine is not among these. 1

Clinical Evidence for Ubrelvy

• The 2023 VA/DoD Clinical Practice Guideline for Management of Headache suggests ubrogepant for the short-term treatment of migraine (weak recommendation). 2
• Ubrelvy demonstrated efficacy in phase 3 trials, with 19.2% of patients on 50 mg and 21.2% on 100 mg achieving pain freedom at 2 hours, compared to 11.8% on placebo. 3
• The most common adverse events with Ubrelvy are nausea (2.1-4.1%), somnolence, and dry mouth, with an overall favorable safety profile. 3, 4

Dosing Recommendations

• Standard dosing is 50 mg or 100 mg at migraine onset, with the option to take a second dose 2 hours after the first if needed. 1
• Patients should not take more than 8 migraine treatments with Ubrelvy in 30 days. 1
• A second dose within 24 hours should be avoided if the patient is taking moderate CYP3A4 inhibitors (which does not include paroxetine) or consuming grapefruit juice. 1

Important Considerations for Depression Comorbidity

• Paroxetine is an appropriate first-line SSRI for major depressive disorder and anxiety disorders, with established efficacy and tolerability. 5
• SSRIs like paroxetine are not effective for migraine prevention in most patients, so the patient will need separate acute and potentially preventive migraine therapy. 6
• If migraine prevention becomes necessary (attacks >2 days/week), consider amitriptyline, topiramate, or propranolol rather than relying on the SSRI for dual benefit. 2, 6

Critical Frequency Limitation

• Limit Ubrelvy use to no more than 2 days per week to prevent medication-overuse headache, which can paradoxically increase headache frequency. 7
• If the patient requires acute migraine treatment more than twice weekly, initiate preventive therapy immediately. 8, 7

Monitoring and Follow-Up

• Instruct the patient to maintain a headache diary tracking frequency, triggers, and medication use to assess treatment efficacy. 8
• Reassess after 3 months to determine if preventive therapy is needed based on attack frequency and disability. 8
• Monitor for any allergic reactions to Ubrelvy, which can occur within hours to days after dosing, though most are not serious. 1