Nurtec (Rimegepant) Is Not Indicated for Palpitations
Nurtec (rimegepant) is not effective for treating palpitations and should not be used for this indication. Rimegepant is a CGRP receptor antagonist approved exclusively for acute migraine treatment and migraine prevention in adults—it has no therapeutic role in managing cardiac symptoms like palpitations 1, 2.
What Nurtec Actually Treats
Rimegepant is FDA-approved for two specific indications 1, 2:
- Acute treatment of migraine with or without aura in adults
- Preventive treatment of episodic migraine in adults
The medication works by blocking calcitonin gene-related peptide (CGRP) receptors, which are involved in migraine pathophysiology—not cardiac rhythm or palpitation mechanisms 2, 3.
Safety Profile Regarding Cardiac Symptoms
While rimegepant has been studied extensively for cardiovascular safety in migraine patients, the data addresses whether it causes cardiac problems, not whether it treats them 4:
- No significant cardiovascular adverse events were attributed to rimegepant in clinical trials 4
- One isolated case of first-degree atrioventricular block was considered possibly related to rimegepant, but this represents a conduction abnormality, not treatment of palpitations 4
- The medication showed no dose-related trends in heart rate in pharmacokinetic studies with doses up to 1500 mg 5
Critical Distinction
If your patient is experiencing palpitations during migraine attacks, rimegepant may help resolve the migraine itself, which could secondarily reduce associated symptoms 2, 3. However, this is fundamentally different from treating palpitations as a primary indication.
What to Do Instead
For a patient with both migraines and palpitations:
- Evaluate the palpitations separately with appropriate cardiac workup (ECG, Holter monitor, echocardiogram as indicated)
- Use rimegepant only for migraine management according to approved dosing: 75 mg orally disintegrating tablet for acute attacks, or 75 mg every other day for prevention 2, 3
- Address palpitations with cardiology consultation and appropriate antiarrhythmic therapy, beta-blockers, or other cardiac-specific interventions as warranted by the underlying etiology
Common Pitfall to Avoid
Do not prescribe rimegepant expecting any direct effect on palpitations—this represents off-label use without evidence and could delay appropriate cardiac evaluation and treatment for a potentially serious symptom.