What is Ubrelvy (Ubrogepant)?

From the Guidelines

Ubrelvy (ubrogepant) is a recommended treatment option for moderate to severe acute episodic migraine headache in nonpregnant outpatient adults who do not tolerate or have inadequate response to combination therapy of a triptan and an NSAID or acetaminophen, as supported by the American College of Physicians guideline 1.

Key Points

• Ubrelvy works by blocking calcitonin gene-related peptide (CGRP) receptors, which play a key role in migraine pain signaling.
• The standard dosing is 50 mg or 100 mg taken as a single dose at the onset of migraine symptoms, with a second dose possible after 2 hours if needed (maximum 200 mg in 24 hours).
• Common side effects include nausea, tiredness, and dry mouth.
• Unlike older migraine treatments like triptans, Ubrelvy doesn't cause blood vessel constriction, making it potentially safer for people with cardiovascular risks.
• Patients should inform their doctor about all other medications they take, as Ubrelvy interacts with certain drugs, particularly strong CYP3A4 inhibitors like ketoconazole or clarithromycin, which may require dose adjustments.

Clinical Considerations

• The choice of a specific NSAID or triptan should be based on individualized decision making, taking into consideration patient preferences on such factors as route of administration and cost 1.
• Consider using a nonoral triptan and an antiemetic in people having severe nausea or vomiting.
• Counsel patients to begin treatment of migraine headache as soon as possible after its onset, using combination therapy (such as a triptan with an NSAID or acetaminophen) to improve efficacy.
• Patients should be aware of medication overuse headache, which is a potential complication of migraine treatment, and defined as headache occurring on 15 or more days per month for at least 3 months in people with a preexisting headache disorder that develops because of overuse of acute medication 1.

From the FDA Drug Label

UBRELVY is a prescription medicine used for the acute treatment of migraine attacks with or without aura in adults. The main use of Ubrelvy is for the acute treatment of migraine attacks in adults.

• It is not used to prevent migraine headaches.
• The safety and effectiveness of Ubrelvy in pediatric patients have not been established.
• Ubrelvy is not known if it is safe and effective in children 2.

From the Research

Ubrelvy Overview

• Ubrelvy, also known as ubrogepant, is an oral, small-molecule calcitonin gene-related peptide receptor antagonist for acute migraine treatment 3.
• It is available for the treatment of migraine with or without aura in adults.

Efficacy and Safety

• Ubrogepant has been shown to be effective in relieving pain and the most bothersome symptom when taken as needed for the acute treatment of migraine 3, 4.
• The percentage of participants who had freedom from pain at 2 hours was 19.2% in the 50-mg ubrogepant group and 21.2% in the 100-mg ubrogepant group, compared to 11.8% in the placebo group 3.
• Ubrogepant has been found to have a favorable safety profile, with the most common adverse events being nausea, somnolence, and dry mouth 3, 4.
• Ubrogepant had overall the best tolerability profile compared to lasmiditan and rimegepant 4.

Comparison to Other Treatments

• Ubrogepant has been compared to triptans, which are commonly used for migraine treatment, and was found to have lower odds ratios for pain freedom and pain relief at 2 hours 5.
• However, ubrogepant may offer an alternative to triptans due to its lack of cardiovascular risks 5.
• Ubrogepant may be used in severe hepatic disease with dose adjustment, and lasmiditan can be used in end-stage renal disease 6.

Usage in Special Populations

• Ubrogepant can be used in patients with renal or hepatic disease, but dose adjustments may be necessary 6.
• The use of NSAIDs should be limited in patients with severe hepatic or renal disease, and triptans can be selectively used with dose guideline adjustments 6.