Rimegepant ODT (Generic Nurtec) - Uses, Side Effects, and More

Everything you need to know about Rimegepant ODT

How does Rimegepant ODT work?

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.

Rimegepant 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 rimegepant, 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. Rimegepant is also known as a CGRP antagonist.

How should I take Rimegepant ODT?

Rimegepant is available as a 75 mg tablet. It should be taken on alternate days to prevent future migraine headaches.

As this medication can only be taken once in a 48 hour period, 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 ONE tablet (of 75 mg each) in a 48 hour period.

How long after I start taking Rimegepant will I see a reduction in my migraine attacks?

Every person is different, and some migraine sufferers will only start to see benefits from taking Rimegepant 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 Rimegepant 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.

What do I need to tell my doctor before taking Rimegepant ODT?

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 Rimegepant):

Hypersensitivity (allergy) to Rimegepant or any ingredients in its formulation.
Ongoing treatment, or treatment in the last 24 hours with medication that is also processed by the same liver enzymes (eg CYP3A4 inhibitors, CYP3A inducers, P-glycoprotein inhibitors (amiodarone, clarithromycin, ciclosporin, colchicine, diltiazem, erythromycin, felodipine, ketoconazole, lansoprazole, omeprazole and other proton-pump inhibitors, nifedipine, paroxetine, reserpine, saquinavir, sertraline, quinidine, tamoxifen, verapamil, and duloxetine).

Please notify your doctor if you have any history of severe liver disease.

Rimegepant can be prescribed safely in patients with mild, moderate, or severe kidney disease and in mild or moderate liver disease.

There are no specific concerns in healthy elderly volunteers.

Rimegepant 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.

What are some of the side effects that I might experience?

Rimegepant 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:

Digestive:

Nausea.

Abnormal feeling:

Nil.

Cardiovascular:

Nil.

Brain and nerves:

Nil.

Skin:

Rash.

Other:

Nil.

If you are unhappy with any side effects that you experience, please speak to the clinical team and stop your treatment.

Further information on detailed side effects can be found in the official FDA drug label information for Rimegepant:

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9ef08e09-1098-35cc-e053-2a95a90a3e1d

What are the side effects that mean I need to call my doctor immediately?

If at any time you experience any worrying or potentially serious side effects, stop taking Rimegepant 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 Rimegepant.

Symptoms include but are not limited to:

Skin rash.

In addition, stop taking this medication, and seek appropriate medical advice in the following situations:

A suspected allergy to Rimegepant eg difficulty breathing, facial swelling (if in any doubt seek emergency medical advice).
You have been advised by your doctor to take a medication that is likely to interact with Rimegepant.
You have been advised to stop taking this medication by a healthcare professional.

Please inform us of any changes to your medical health, including new medication or treatment.

What should I be very cautious of?

Taking alcohol can increase some of the side effects of Rimegepant. Try to avoid alcohol consumption completely, especially within 6 hours of your dose.

Can I take other migraine medication with this?

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.

Mable Phone Number: 855-953-4316
Hours: 7am-7pm PST Mon-Fri & 9am-5pm PST Sat-Sun.

What other similar medications are available?

Preventative migraine medications available:

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®).

Titration Guidelines for Rimegepant ODT

Titration Guidelines

What dose will I take to prevent migraines?

Some preventative medications require titration to an optimal dose. (The dose that is effective in preventing your migraines, with little to no side effects.) This is not applicable to Rimegepant as this medication can only be taken once in a 48 hour period.

How do you know if your treatment is working?

Put on the spot, it is often difficult to compare before and after taking medication! We recommend keeping a migraine diary. Record the number of migraines headaches that you experience each week, and their intensity. Also make a note of all medications, and supplements that you are taking. It may also help to record any side effects that you are experiencing.

You may notice benefits directly such as fewer headaches occurring, or less intense headaches that are more easily relieved with acute drugs. You may notice more benefit from other techniques that you use to make yourself comfortable during a headache (such as lying down or sleeping, going to a dark and quiet place).

Alternatively you may feel the benefits in other ways: you may feel more rested, or notice an improvement in sleeping patterns, it might be that you feel more productive at work or at home, or you feel able to take part in more family, social or leisure activities.

Remember you may only notice a difference in your migraines after consistently taking your medication for at least three months.

Titration Summary

Rimegepant is only to be taken once in a 48 hour period.
Every two weeks review whether you are having fewer migraines, and whether you are having side effects. If you are yet to see the full benefit of treatment (prevention of migraines) you may need to continue Rimegepant for at least three months to see benefits in migraine frequency and intensity reduction.

Always remember that you can contact the Mable support line for further information on titrating your medication.

Mable Phone Number: 855-953-4316

Hours: 7am-7pm PST Mon-Fri & 9am-5pm PST Sat-Sun.

Down-titration (Tapering) Summary

The goal of down-titration is to stop your current medication safely. This may be to stop treatment. Alternatively down-titration may allow you to replace your current medication for a migraine preventative that is more suited to you.

If you are on Rimegepant you can immediately stop. However, if you decrease a dose and experience intolerable migraine symptoms, consider acute migraine analgesia in the first instance. If migraines are intolerable you may need to return to the previous dose and frequency.

(With other preventative medications the down-titration process involves gradually decreasing the dose of the migraine preventative medication until it can be stopped safely.)

Always remember that you can contact the Mable support line for further information on titrating your medication.

Mable Phone Number: 855-953-4316

Hours: 7am-7pm PST Mon-Fri & 9am-5pm PST Sat-Sun.

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