Atogepant (brand name Qulipta®) is a prescription medication to be taken every other day as a preventative migraine medication. It also has the benefit of acute relief of headache symptoms during a migraine, ie it also has some immediate effect.
In many migraine sufferers, there is a problem with the membranes that surround and protect the brain. These membranes are called meninges and are sensitive to pain, in much the same way the membranes of the eye can be irritated by dust or chemicals. This makes our eyes itch and become inflamed, a natural healing response.
In a migraine there is activation of pain reflexes in the nerves supplying the meninges. The nerve most affected is the trigeminal nerve which responds by releasing pain- and inflammation-causing chemicals. This inflammation results from changes in the blood vessels in the brain, making them relax (the more accurate term is dilate).
In the healing process, inflammation allows our immune system to fix a cut, or fight a bug. In a migraine however this inflammation is not helpful, it causes redness, heat, swelling and pain, caused by certain proteins and chemicals leaving the bloodstream and surrounding the nerves.
As a consequence, the trigeminal nerve continues to sense pain even after the initial migraine trigger has passed; this inflammation can persist into a long-standing or chronic state. This is believed to cause increased sensitivity to pain and making further migraines more likely to happen i.e. chronic migraines.
Atogepant reduces or blocks the production of one of the chemicals called calcitonin gene-related peptide (CGRP) that acts on the blood vessels to cause inflammation in the coverings of the brain. CGRP receptor antagonists, which include drugs like Atogepant, work to stop the binding of CGRP preventing inflammation. With less inflammation in the arteries and in the brain there is less redness, heat, and swelling. This can reduce the level of pain that a patient experiences. Over time reducing this inflammation acts to prevent future migraines. Atogepant is also known as a CGRP antagonist.
Atogepant is available as 10 mg, 30 mg and 60 mg tablets. It should be taken every day to prevent future migraine headaches.
As this medication can take some time to reach full effect, if you require more immediate relief of symptoms it is worth considering additional acute migraine relief in the meanwhile. Further information can be found below in, “Can I take other migraine medication with this?”
Please read the prescription instructions provided and follow them closely. Do not take more than 60 mg in a 24 hour period.
Every person is different, and some migraine sufferers will only start to see benefits from taking Atogepant once they have been taking it for three months. However, some people may notice a reduction in migraine intensity and frequency earlier than this.
Currently it is recommended to continue with the Atogepant for three months, before considering another type of preventive medication. Please contact our support line should you have queries about your titration plan, the dose that you should be taking or any other concerns that you may have about your treatment plan.
We advise keeping medication in a dry, cool space, and out of direct sunlight. Medication should be stored away from the reach of children and pets, and kept inside its airtight container until ready to be taken.
Expiry dates may be supplied by the medication manufacturer or by the pharmacist supplying the medication. Once an expiry date has been passed, a medicine may not be safe or as effective to use.
You must tell your doctor if you have a history or suspected diagnosis of any of the following contraindications. (A contraindication means any condition where you must NOT take Atogepant):
Please notify your doctor if you have any history of severe kidney disease or severe liver disease.
Atogepant can be prescribed safely in patients with mild, or moderate kidney disease and in mild or moderate liver disease.
There are no specific concerns in healthy elderly volunteers.
Atogepant is not safe during pregnancy, breastfeeding, whilst trying to conceive or during fertility treatment. It must be stopped at least six months before falling pregnant as there is an increased risk of major birth defects and intra-uterine growth restriction (IUGR) during pregnancy. We advise considering alternative options for initial migraine medication in these circumstances
We suggest seeking advice if you are concerned by any significant increase in duration, frequency or severity of your migraine symptoms.
Atogepant can have great benefits to reduce your migraine symptoms, although some individuals may experience side effects which are important to notice and be aware of. Common side-effects include:
If you are unhappy with any side effects that you experience, please speak to your doctor and stop your treatment.
Further information on detailed side effects can be found in the official FDA drug label information for Atogepant: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8c8ab8f4-32bd-497a-befa-70c8a51d8d52
If at any time you experience any worrying or potentially serious side effects, stop taking Atogepant and seek immediate medical advice. If there is any doubt contact emergency services and state your symptoms and that you have taken a migraine medication called Atogepant.
Symptoms include but are not limited to:
In addition, stop taking this medication, and seek appropriate medical advice in the following situations:
Please inform us of any changes to your medical health, including new medication or treatment.
Taking alcohol can increase some of the side effects of Atogepant. Try to avoid alcohol consumption completely, especially within 6 hours of your dose.
Yes, you can continue to take acute migraine treatment such as triptans as well as simple analgesics such as Aspirin, Ibuprofen and acetaminophen.
Preventative medications can interact to have a much greater effect than taking a single medication alone. We would not advise taking more than one preventative medication at a time. Examples of other preventative migraine medications include: Topiramate, Carbamazepine, Fosphenytoin, Phenobarbital, Phenytoin, Primidone, Valproate, and Zonisamide.
Atogepant is a prescription medication to be taken every day as a preventative migraine medication. It also has the benefit of acute relief of headache symptoms during a migraine. It has mechanisms of action which can affect, or be affected by other medical conditions or medications. Check your prescription carefully for dosage and seek medical advice if you are unsure, or become unwell.
Atogepant tablets are available containing 10 mg, 30 mg and 60 mg of active Atogepant.
Topiramate (generic Topamax®), Sodium valproate (Extended release) (generic Depakote ER®), Gabapentin (Extended release) (generic Gralise ER®, Neurontin ER®), Amitriptyline (generic Elavil®), Nortriptyline (generic Pamelor®), Venlafaxine (Extended release) (generic Effexor XR®), Propranolol (generic Inderal LA®), Atenolol (generic Tenormin®), Metoprolol (Extended release) (generic Toprol XL®), Timolol (generic Timol®), Candesartan (generic Atacand®), Verapamil (Extended release) (generic Calan SR®), Rimegepant (generic Nurtec ODT®), Galcanezumab (generic Emgality®).
Please see our website for further information, or speak to your doctor or pharmacist.
For detailed FDA approved medication information please visit the link below: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8c8ab8f4-32bd-497a-befa-70c8a51d8d52
We recommend reading and familiarizing yourself with this information prior to commencing treatment with Atogepant.
We kindly request that you report any and all negative side effects to the FDA via this link below:
https://www.fda.gov/Safety/MedWatch/default.htm or call 1-800-FDA-1088.
Do not use Atogepant if you are trying to conceive, during pregnancy or breastfeeding. It must be stopped at least six months before falling pregnant as there is an increased risk of major birth defects and intra-uterine growth restriction (IUGR) during pregnancy.
If you’re ready for enhanced DNA-guided Migraine Care, take the Mable quiz and see if Qulipta is for you.
Photo by Tim Mossholder.