Rimegepant
NURTEC
What it isCGRP-receptor antagonist; acute treatment and prevention of migraine.
Why this oneIt serves both acute and preventive roles and, unlike triptans, does not cause vasoconstriction.
What limits itStrong CYP3A4 inhibitors must be avoided; cost and prior authorization frequently block access.
FDA-approved for
- migraine (acute/prevention) (2020)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Acute treatment of migraine | adult | 75 mg PRN | 75 mg PRN | 75 mg/24 h |
| Preventive treatment of episodic migraine | adult | 75 mg every other day | 75 mg every other day | 75 mg every other day |
Renal Mild-moderate-severe: no adjustment; avoid in ESRD (CrCl <15)
Hepatic Mild-moderate (Child-Pugh A/B): no adjustment; avoid in severe (Child-Pugh C)
Acute: max 75 mg/24 h; safety of >18 doses per 30 days not established. Avoid another dose within 48 h of a moderate CYP3A4 inhibitor or potent P-gp inhibitor
Instructions
- Use dry hands; peel back blister foil, do not push tablet through
- Place on or under the tongue; it disintegrates in saliva without additional liquid
- Take immediately after opening; with or without food
- Avoid strong CYP3A4 inhibitors and strong/moderate CYP3A inducers
Cautions
- Serious hypersensitivity reactions (anaphylaxis, dyspnea, rash), can occur days after dosing; discontinue
- Hypertension (new-onset or worsening)
- Raynaud's phenomenon (new-onset or worsening)
Adverse reactions
- Nausea
- Abdominal pain/dyspepsia (prevention)
Pregnancy No adequate human data; animal effects (decreased fetal weight, skeletal variations) at high maternally toxic doses
Lactation Low transfer into breast milk (relative infant dose <1%)
NO BOXED WARNINGS
Principal riskLittle; CYP3A4-dependent
Cost, est. cash$500–$1,200/month
Generic entry2039 est.
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilityAgent-specific vascular, serotonergic or hepatic risks; acute overdose is usually limited outside ergot or cardiovascular agents.
Mechanism of action: Rimegepant ballicule
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