Can Qulipta (Atogepant) Be Taken with Myfembree?
Yes, atogepant can be safely taken with Myfembree (relugolix, estradiol, and norethindrone acetate), as there are no clinically significant drug interactions between these medications.
Drug Interaction Profile
Atogepant does not interact with hormonal contraceptives or hormone replacement therapies. The FDA label for atogepant explicitly states that co-administration with oral contraceptive components ethinyl estradiol and levonorgestrel did not result in significant pharmacokinetic interactions for either atogepant or the co-administered drugs 1. This finding extends to other estrogen and progestin combinations like Myfembree.
Key Pharmacologic Considerations
Atogepant is not a CYP450 enzyme inhibitor or inducer at clinically relevant concentrations, meaning it will not alter the metabolism of Myfembree's hormonal components 1
Myfembree does not contain strong CYP3A4 inhibitors or inducers that would significantly affect atogepant levels, as the only clinically significant interactions with atogepant occur with strong CYP3A4 inhibitors (which increase atogepant exposure 5.5-fold) or strong CYP3A4 inducers (which decrease atogepant exposure by 60%) 1, 2
Atogepant does not inhibit major drug transporters (P-gp, BCRP, OAT1, OAT3) at clinically relevant concentrations, eliminating concerns about transporter-mediated interactions 1
Clinical Management
No dose adjustments are needed for either medication when used concomitantly. Patients can take their standard prescribed doses:
- Atogepant: 30 mg twice daily or 60 mg once daily for chronic migraine prevention 3, 4
- Myfembree: as prescribed for endometriosis or uterine fibroids
Monitoring Recommendations
Standard monitoring for each medication individually is sufficient, with no additional safety surveillance required for the combination 1
Common atogepant side effects (constipation 10-11%, nausea 8-10%) should be monitored but are unrelated to hormonal therapy 3
Weight changes may occur with atogepant (≥7% decrease in 6% of patients), which should be distinguished from any weight effects of Myfembree 3
Important Caveats
The only contraceptive-related concern with atogepant involves aprepitant (an antiemetic), not atogepant. Aprepitant decreases oral contraceptive efficacy and requires alternative birth control methods, but this does not apply to atogepant, which has a completely different mechanism and interaction profile 5, 1.
Patients taking strong CYP3A4 inhibitors or inducers for other conditions would require atogepant dose adjustments, but Myfembree is not in either category 1, 2.