Rimegepant

DAE Class; Rx

Common Brand Names; Nurtec ODT

• Antimigraine Agents; 
• CGRP Receptor Antagonists

Calcitonin gene-related peptide (CGRP) receptor antagonist; binds to CGRP receptor, which is thought to be causally involved in migraine pathophysiology

Indicated for acute treatment of migraine with or without aura

Indicated for preventive treatment of episodic migraine

History of hypersensitivity to rimegepant; delayed serious hypersensitivity reported

1-10%

Nausea (2%)

<1%

Hypersensitivity, including dyspnea and severe rash

Hypersensitivity

• Hypersensitivity reactions, including dyspnea and rash, reported
• Reactions can occur days after administration, and delayed serious hypersensitivity has occurred
• If a hypersensitivity reaction occurs, discontinue rimegepant and initiate appropriate therapy

Drug interaction overview

• Strong or moderate CYP3A4 inhibitors

  • Strong CYP3A4 inhibitors: Avoid coadministration; coadministration results in significant increase in rimegepant exposure
  • Moderate CYP3A4 inhibitors: If coadministered, avoid another dose of rimegepant within 48 hr

• Strong or moderate CYP3A inducers

  • Avoid coadministration
  • Coadministration may result in significant reduction in rimegepant exposure and loss of efficacy

• Inhibitors of P-gp or BCRP

  • Avoid coadministration
  • Coadministration may result in significant increase in rimegepant exposure

Pregnancy

Data are not available regarding the developmental risk associated with use in pregnant women

Lactation

Results from a lactation study established a relative infant dose (<1% of maternal weight-adjusted dose) and milk-to-plasma ratio was 0.2

There are no data on effects of rimegepant on breastfed infants or on milk production

Migraine Treatment

Indicated for acute treatment of migraine with or without aura

75 mg PO as needed

Not to exceed 75 mg per 24-hr period

Safety of >18 doses/30 days has not been established

Migraine Prevention

Indicated for preventive treatment of episodic migraine

75 mg PO every other day

Dosage Modifications

CYP3A4 inhibitors

• Strong: Avoid coadministration
• Moderate: Avoid another dose of rimegepant within 48 hr when coadministered

CYP3A4 inducers

• Strong or moderate: Avoid coadministration

P-gp or BCRP inhibitors

• Avoid coadministration

Renal impairment

• Mild, moderate, or severe (CrCl ≥15 mL/min): No dosage adjustment required
• End-stage renal disease (CrCl <15 mL/min): Avoid; not studied

Hepatic impairment

• Mild or moderate (Child-Pugh A or B): No dosage adjustment required
• Severe: Avoid

Rimegepant