Nurtec (Rimegepant) Side Effects for Perimenopause Migraines
Nurtec ODT is generally well tolerated with nausea being the most common side effect, occurring in approximately 2-15% of patients, whether used for acute treatment or prevention of migraine. 1, 2
Most Common Side Effects
For Acute Treatment (As-Needed Dosing)
- Nausea is the primary side effect reported in clinical trials 1, 3
- Urinary tract infection 3
- Dizziness 3
For Preventive Treatment (Every-Other-Day Dosing)
- Nausea (most common) 1, 2
- Stomach pain (abdominal pain) 1
- Indigestion (dyspepsia) 1
- Constipation (1.0% in long-term studies) 4
- Upper respiratory tract infection (0.8%) 4
- Weight increase (0.7%) 4
Serious but Rare Side Effects
Allergic Reactions
- Allergic reactions can occur days after taking Nurtec ODT and require immediate medical attention 1
- Symptoms include:
Liver Safety Profile
- No evidence of hepatotoxicity has been identified in clinical trials, including long-term studies up to 52 weeks 2, 4
- In the 52-week open-label extension study, hepatic-related adverse events occurred in only 1.8% of participants 4
- Only 0.3% discontinued due to liver enzyme-related adverse events 4
- No participant experienced ALT or AST >3× upper limit of normal concurrent with total bilirubin >2× upper limit of normal 4
Cardiovascular Safety
- No evidence of cardiovascular toxicity has been demonstrated in clinical trials 2
- Rimegepant works through a nonvasoconstrictive mechanism (CGRP receptor antagonism without serotonergic activity), potentially carrying lower cardiovascular risks than triptans 5
Overall Tolerability Profile
- Most adverse events are mild in severity; severe adverse events occurred in only 2.3% of participants in long-term studies 4
- Serious adverse events are uncommon (2.2% in 52-week studies), with none being liver-related 4
- Discontinuation due to adverse events is rare (2.8% over 52 weeks) 4
- Treatment-related adverse events occurred in 15.1% of participants, with most being mild 4
Special Considerations for Perimenopausal Women
Pregnancy and Breastfeeding Concerns
- Very small amounts of Nurtec ODT pass into breast milk 1
- Safety during pregnancy is not fully established; women who become pregnant while taking Nurtec ODT should enroll in the MONITOR pregnancy registry by calling 1-877-366-0324 1
Dosing Limits to Prevent Side Effects
- For acute treatment: do not take more than 1 tablet in 24 hours 1
- It is not known if taking more than 18 doses in 30 days is safe 1
- For preventive treatment: take 1 tablet every other day 1
Long-Term Safety Data
- In a 52-week study, 71% of participants completed the full year of treatment, demonstrating good long-term tolerability 4
- No diminution of effect or tolerance development was observed over 52 weeks 4
- The safety profile remained favorable with both every-other-day scheduled dosing and as-needed dosing 4
Concomitant Use with Other CGRP Therapies
- Rimegepant appears safe when used concomitantly with CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab) for patients requiring both acute and preventive treatment 6
- In a substudy of 13 patients using rimegepant with CGRP mAbs, only 38% reported any adverse events, all mild to moderate 6
Common Pitfalls to Avoid
- Do not push the tablet through the foil packaging; peel back the foil to avoid damaging the orally disintegrating tablet 1
- Do not store tablets outside the blister pack for future use 1
- Patients with liver or kidney problems should inform their healthcare provider before starting Nurtec ODT 1
- Monitor for allergic reactions, which can occur days after administration, not just immediately 1