From the Guidelines
It is generally not recommended to take Nurtec (rimegepant) and a triptan medication together for migraine treatment, as this combination may increase the risk of side effects without providing additional benefit, according to the most recent guideline from the American College of Physicians 1.
Key Considerations
- The American College of Physicians recommends combination therapy of a triptan and an NSAID or acetaminophen in nonpregnant adults seeking acute treatment of an episodic migraine who have an inadequate response to NSAIDs and acetaminophen monotherapies 1.
- However, the guideline does not specifically address the combination of Nurtec (rimegepant) and a triptan medication, but it does suggest that CGRP antagonists-gepants (such as rimegepant) may be used to treat 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 1.
- It is essential to consult with a healthcare provider to create a clear treatment plan that specifies which medication to use in different situations and how to properly space them, as the combination of these medications may increase the risk of serious cardiovascular effects 1.
Treatment Approach
- Consider treating mild episodic migraine headache with an NSAID, acetaminophen, or the combination of an NSAID and acetaminophen 1.
- For moderate to severe acute episodic migraine headache, consider using CGRP antagonists-gepants (such as rimegepant) or ergot alkaloid (dihydroergotamine) in nonpregnant outpatient adults who do not tolerate or have inadequate response to combination therapy of a triptan and an NSAID or acetaminophen 1.
- Patients should be aware of medication overuse headache, which is a potential complication of migraine treatment, and be counseled 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 1.
From the Research
Migraine Treatment Options
- There are various treatment options available for migraine, including triptans, non-steroidal anti-inflammatory drugs (NSAIDs), acetylsalicylic acid (ASA), acetaminophen, ergots, opioids, and anti-emetics 2.
- Rimegepant (Nurtec) is a calcitonin gene-related peptide (CGRP) receptor antagonist approved for the acute treatment of migraine with or without aura in adults, and for the preventive treatment of episodic migraine in adults 3.
Combination Therapy
- The use of triptans in combination with other drugs, such as ASA or acetaminophen, may be associated with slightly better outcomes than standard dose triptan tablets 2.
- Rimegepant was effective for the acute treatment of migraine in adults with a history of insufficient response to 1 or ≥2 triptans and in current triptan users 4.
Efficacy of Rimegepant and Triptans
- Rimegepant was more effective than placebo at relieving pain and the most bothersome symptom when taken as needed for the acute treatment of migraine 3.
- Triptans, such as eletriptan, zolmitriptan, and sumatriptan, were among the most effective medications for acute migraine treatment, with odds ratios (ORs) ranging from 5.2 to 6.1 5.
Safety and Tolerability
- Rimegepant was generally well tolerated, with no evidence of hepatotoxicity or cardiovascular toxicity in clinical trials 3.
- The safety and tolerability of combination therapy with rimegepant and triptans have not been extensively studied, and caution should be exercised when using these medications together 4, 3.