Migraine, characterized by throbbing pain in the head, is a common primary headache. It is often accompanied by sensitivity to light and sound, as well as nausea and vomiting. Migraines are divided into episodic migraines with or without aura and chronic migraines, with chronic migraines being less common. Several options are available for the acute and preventive treatment of migraines. Nurtec (rimegepant) is one of the medications used to treat and prevent migraines. This article provides comprehensive information about Nurtec ODT, its uses, side effects, precautions, and other important details.
What is Nurtec ODT?
Nurtec is an orally disintegrating tablet (ODT) used for the acute treatment of migraine attacks with or without aura and for the prevention of episodic migraine in adults. It belongs to a class of drugs known as calcitonin gene-related peptide (CGRP) receptor antagonists. During migraine attacks, CGRP levels are elevated, and Nurtec works by blocking CGRP, thus helping to alleviate migraine symptoms.
How Nurtec ODT Works
CGRP is a protein that binds to receptors in the brain, triggering migraine attacks and playing a role in pain transmission. Nurtec ODT blocks CGRP, preventing it from attaching to these receptors and reducing headache pain and duration.
Dosage and Administration
Nurtec is available as a 75 mg ODT. The dosage for acute treatment of migraine is one tablet daily as needed. For preventive treatment of episodic migraine, it is taken once every other day. It is important not to take more than one tablet in 24 hours and not more than 18 doses in a 30-day period.
Nurtec ODT tablets are packaged in blister packs containing eight tablets. It is crucial to store the tablets in their original packaging to protect them from moisture. Begin by peeling the back cover of one blister and gently removing the tablet without pushing it through the foil. The tablet should be taken immediately after removal from the blister. Place the tablet on or under the tongue, where it will dissolve quickly and can be swallowed with saliva. No water is needed.
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Common Side Effects of Nurtec ODT
Like all medications, Nurtec ODT can cause side effects. The most common side effects reported in clinical trials include:
- Nausea
- Indigestion
- Abdominal pain
These side effects are generally mild and temporary, lasting a few days to weeks. However, if these side effects persist, worsen, or become difficult to tolerate, it is essential to consult a doctor or pharmacist.
Nausea
Nausea was the most commonly reported side effect in clinical trials of Nurtec ODT. If nausea occurs, it can be managed with the following strategies:
- Taking Nurtec ODT with food.
- Drinking fluids in small amounts.
- Using a cold compress on the base of the head.
- Eating a bland, small snack such as plain toast or crackers.
- Drinking water, chamomile tea, or ginger tea.
- Consulting a doctor about anti-nausea medications like promethazine.
Indigestion
Indigestion was another common side effect reported when Nurtec ODT was taken for preventive treatment of migraine episodes. Symptoms of indigestion may include:
- Burning sensation or pain in the stomach.
- Feeling more full than usual after eating.
- Feeling full more quickly than usual after eating.
To manage indigestion, consider the following:
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- Drinking water, mint tea, or cinnamon tea.
- Eating plain foods such as rice, bananas, or toast.
- Having a warm bath.
- Consulting a doctor about antacids or H2 blockers.
Abdominal Pain
Abdominal pain was also reported in clinical trials of Nurtec ODT when used for migraine prevention. If abdominal pain becomes bothersome, it is important to consult a doctor for suggestions on how to ease the pain.
Serious Side Effects of Nurtec ODT
Although less common, Nurtec ODT can cause serious side effects, including allergic reactions, high blood pressure, and Raynaud’s phenomenon.
Allergic Reactions
Nurtec ODT can cause allergic reactions, which can be serious and require immediate medical attention. Symptoms of an allergic reaction may include:
- Skin rash
- Shortness of breath
- Itching
- Flushing
- Swelling under the skin, typically in the lips, eyelids, hands, or feet
- Swelling of the mouth, tongue, or throat, which can make it hard to breathe
If you experience any of these symptoms, seek emergency medical help immediately.
High Blood Pressure
Nurtec ODT may cause high blood pressure or worsen existing high blood pressure. Symptoms of high blood pressure may include blurred vision, dizziness, headache, nervousness, pounding in the ears, or a slow or fast heartbeat. Regular monitoring of blood pressure is advisable, especially when starting treatment with Nurtec ODT. Contact your healthcare provider if you notice an increase in blood pressure.
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Raynaud's Phenomenon
Raynaud's phenomenon, a circulation problem, can worsen or occur after taking Nurtec ODT. This condition can cause the fingers or toes to feel numb, cool, or painful, or change color from pale to blue to red. If you experience these symptoms, contact your healthcare provider immediately.
Precautions and Warnings
Before taking Nurtec ODT, it is important to inform your doctor about your medical history, including any existing medical conditions and medications you are taking.
Severe Liver and Kidney Problems
Nurtec ODT is not recommended for patients with severe liver impairment or end-stage renal disease. These conditions can increase the level of the drug in the body, potentially increasing the risk of side effects.
Pregnancy and Breastfeeding
There is limited data on the developmental risks associated with Nurtec ODT use during pregnancy and breastfeeding. Patients who are pregnant or breastfeeding should notify their doctor before initiating treatment. If you take Nurtec ODT during pregnancy, consider enrolling in the Migraine Observational NURTEC Pregnancy Registry (MONITOR) to collect safety information about the use of Nurtec ODT during pregnancy.
Drug Interactions
Nurtec ODT can interact with other medications, potentially affecting its serum concentration. Inform your doctor of all medications, over-the-counter products, and vitamins you are taking before starting Nurtec ODT. Particular caution should be exercised if you have taken any of the following drugs within the last 48 hours:
- Amiodarone
- Cyclosporine
- Lapatinib
- Quinidine
- Ranolazine
Allergies
Patients who are allergic to rimegepant or any of the other ingredients in Nurtec ODT should not take this medication.
Nurtec ODT vs. Other Migraine Medications
Ubrelvy, Qulipta, and Nurtec ODT are all CGRP receptor antagonists used for migraines in adults. While they belong to the same group of medicines, they may have different mechanisms and side effect profiles. Ubrelvy is approved for the acute treatment of migraine attacks, while Qulipta is used for the preventive treatment of migraine. Nurtec ODT is unique in that it is approved for both acute and preventive treatment.
Clinical Studies and Efficacy
Clinical studies have demonstrated the efficacy of Nurtec ODT in relieving migraine symptoms. One study showed that 37% of patients taking Nurtec ODT experienced pain relief within one hour, compared to 31% of patients taking a placebo. Additionally, 22% of patients taking Nurtec ODT returned to normal function within one hour, compared to 16% of those taking a placebo.
Another study evaluated the efficacy of Nurtec ODT as a preventive treatment, with positive results in reducing the frequency of migraine attacks.
Additional Considerations
Cost and Availability
Patients 18 years of age or older with private or commercial health insurance may be eligible to pay as little as $0 for a 30-day supply of Nurtec through the Nurtec OneSource program. Your health care provider can connect you to this service.
Grapefruit and Alcohol
While taking Nurtec ODT, it is advisable to avoid eating grapefruit or drinking grapefruit juice, as they can interact with the medication. Although there are no known interactions between Nurtec ODT and alcohol, alcohol can trigger migraine attacks in some people, so it is best to consult with your healthcare provider.
Headache Diary
Using rimegepant alone or in combination with other migraine medicines for 15 or more days per month may lead to worsening of headache. It may be helpful to keep a headache diary to record headache frequency and drug use.