The approval of medicines called “CGRP antagonists” has led to big changes in how migraines are managed. These medicines work in a different way than older medicines to treat or prevent migraine. The first CGRP antagonists were only available as a shot, and they were only approved to prevent migraine. Nurtec ODT (NUR-tek) was approved in 2020 as the first CGRP antagonist to treat acute migraine that came as an orally disintegrating tablet (ODT). In 2021, it was approved as the first CGRP antagonist to both treat and prevent migraine.
How Does Nurtec Work for Migraine?
Migraine is a condition where you have intense headaches, usually with throbbing pain on one side. The headache can come back again and again and may last up to 72 hours. You may also have what is called an aura, where you have changes in your vision or other symptoms, such as numbness or trouble speaking.
The active ingredient in Nurtec is rimegepant. You may also hear it called a “gepant.” It is a calcitonin gene-related peptide (CGRP) antagonist. CGRP is a protein that causes blood vessels to widen and can lead to pain and inflammation during a migraine. CGRP may also have a role in causing migraine. CGRP antagonists, like Nurtec, prevent CGRP from binding to its receptors and having its effects. Blocking CGRP can help relieve pain during a migraine attack and can help prevent future attacks.
Unlike other oral CGRP antagonists, Nurtec ODT is approved to both treat and prevent migraine.
How Do I Take Nurtec ODT?
Nurtec ODT comes as a 75-milligram orally disintegrating tablet. You put it on or under your tongue and it will dissolve without water. You can take it with or without food.
Keep the tablet in its blister pack until you are ready to take it. Use dry hands when opening the pack and handling the tablet. Peel back the foil cover to remove the tablet. Do not push the tablet through the foil. Take the tablet right after opening the pack and do not store it for later use.
To treat an acute migraine when it happens, take one tablet as needed. Do not take more than one tablet within 24 hours.
To prevent migraine, take one tablet once every other day.
It is not known whether it is safe to use more than 18 doses of Nurtec ODT in a 30-day period. Keep track of how many doses you take to treat and prevent your migraines.
How Was It Studied for Treating and Preventing Migraine, and What Benefits Were Seen?
Two clinical studies were done to see if Nurtec was safe and effective for treating and preventing migraine, compared to a placebo containing no medicine. People in the studies did not know if they were getting Nurtec or the placebo.
The first study looked at the use of Nurtec for treating acute migraine. Efficacy was measured by the percentage of adults who were pain-free or free of their most bothersome migraine symptom (such as nausea or sensitivity to light or sound) 2 hours after their dose.
People were told to treat their migraine if they had moderate to severe pain. They could also take certain other medicines, such as a pain reliever (like acetaminophen or ibuprofen) or an anti-nausea medicine, 2 hours after taking the treatment. They could not take a triptan (such as sumatriptan or eletriptan) within 48 hours of the treatment. About 14% of people in this study were taking medicines to prevent migraine (such as topiramate, propranolol, or amitriptyline), but none were taking other medicines that affected CGRP.
The study included adults who had a history of migraines for at least a year. About 85% of people in the study were female. About 74% of people in the study were White, 21% were Black, and 17% were Hispanic or Latino. The average age of people in the study was 40 years.
A significantly higher percentage of people who took Nurtec saw the benefits below, compared to people who took the placebo.
Free of pain: About 21% of people who took Nurtec were pain-free 2 hours after the dose, compared to about 11% of people who took the placebo.
Free of the most bothersome migraine symptom (such as nausea or sensitivity to light or sound): About 35% of people who took Nurtec were free of their most bothersome symptom at 2 hours after the dose, compared to about 27% of people who took the placebo.
This study also looked at how many people continued to be pain-free 2 to 48 hours after their dose. About 13% of people taking Nurtec had no pain during this time frame, compared to about 5% of people taking the placebo.
The second study looked at the use of Nurtec for preventing episodic migraine. Episodic migraine is when you have up to 14 headache days per month, whereas chronic migraine is at least 15 headache days per month. People in the study took either Nurtec or a placebo every other day for 12 weeks. Efficacy was measured by the change in the average number of monthly migraine days that people had during weeks 9 through 12 of the study.
People in this study could take medicines to treat an acute headache (including acetaminophen, ibuprofen, or a triptan) as needed. About 10% of people in this study were taking medicines to prevent migraine (such as topiramate, propranolol, or amitriptyline), but none were taking other medicines that affected CGRP.
This study included adults who had a history of migraines for at least a year. People in the study had an average of 10 migraine days in the 28 days before the study started. About 81% of people in this study were female. About 80% of people in the study were White, 17% were Black, and 28% were Hispanic or Latino. The average age of people in the study was 41 years.
People in the study who took Nurtec to prevent migraine had fewer migraine days per month than people who took the placebo. People in this study who took Nurtec had about 4.3 fewer migraine days per month during weeks 9 through 12 of the study. People who took the placebo had about 3.5 fewer migraine days.
Your results may differ from what was seen in clinical studies.
How Long Does It Take for Nurtec to Work?
If you are taking Nurtec to treat an acute migraine attack, you should start to see relief of migraine pain or other bothersome symptoms (such as nausea or sensitivity to light or sound) within 2 hours of your dose. Tell your health care provider if it does not reduce your headache pain.
If you take Nurtec to prevent migraine, tell your health care provider if the number of headaches you have per month is not going down. Consider keeping a headache diary to keep track of when you have migraines and when you take your migraine medicines. This can help you and your health care provider find out how well your medicines are working for you.
What Are Possible Side Effects, and How Can I Prevent or Manage Them?
The most common side effects are nausea, stomach pain, and an upset stomach.
If you have stomach pain or an upset stomach, you can try taking the drug with food.
Nausea is also a common symptom that can happen with migraine in general. To help limit nausea, you can try simple steps, like eating bland foods, such as toast or crackers, and avoiding strong smells, such as from cooking, perfume, or smoke. Your health care provider may also prescribe medicine to help manage nausea if you commonly have nausea during a migraine.
These are not all of the possible side effects. Talk with your health care provider if you are having symptoms that bother you. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.
How Often Can I Take Nurtec?
To treat acute migraine, it can be taken as needed, but do not take more than one 75-milligram dose within 24 hours. To prevent migraine, Nurtec should be taken once every other day. There are no studies to say whether it is safe to take more than 18 doses in 30 days.
While not common, a severe allergic reaction may happen with Nurtec. Stop taking Nurtec and get medical help right away if you have symptoms of an allergic reaction, such as trouble breathing or a severe rash. An allergic reaction can happen right away or days after taking the medicine.
You should not take it if you have severe liver or kidney problems.
What Interactions With Foods and Other Medicines Can Happen?
Several medicines can affect the blood levels of Nurtec. Your body has enzymes and proteins that process and remove many types of medicines from the body. Other medicines can affect this process, which may slow down or speed up how Nurtec is broken down or cleared from your body.
For example, taking Nurtec with medicines that inhibit certain enzymes or proteins could increase the amount of Nurtec in your body. This may lead to excessive or dangerous side effects. Grapefruit juice can also inhibit some of these enzymes.
On the other hand, taking it with medicines that induce certain enzymes could decrease the amount of Nurtec in your body. This may cause it to work less well or not work at all.
If you are taking certain medicines that inhibit or induce these enzymes or proteins, you may not be able to take Nurtec at all, or you may not be able to take another dose within 48 hours. Ask your pharmacist or other health care provider if any of your medicines interact with Nurtec.
Tell your health care provider about all the prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, or other supplements you take or have recently taken. Also tell them if you eat grapefruit or drink grapefruit juice. This will help them determine if there are any interactions with Nurtec or if you need a dosage adjustment. Do not start or stop other medicines while taking Nurtec without talking to your health care provider.
How Can I Get Nurtec ODT?
You will need a prescription from a health care provider. Your primary care provider, neurologist, or a headache specialist may prescribe it. You can get it at any pharmacy.
There is a copay card available from the drugmaker that may allow you to pay $0 for your prescription. Whether you are eligible depends on whether you have prescription insurance, and what type of insurance you have. You can find out more at www.nurtec.com/savings.
