rimegepant (Rx)

Brand and Other Names:Nurtec ODT
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

oral disintegrating tablet

  • 75mg

Migraine Treatment

Indicated for acute treatment of migraine with or without aura

75 mg PO

Not to exceed 75 mg per 24-hr period

Safety of treatment >15 migraines/30 days has not been established

Dosage Modifications

CYP3A4 inhibitors

  • Strong: Avoid coadministration
  • Moderate: Avoid another dose of rimegepant within 48 hr when coadministered

CYP3A4 inducers

  • Strong or moderate: Avoid coadministration

P-gp or BCRP inhibitors

  • Avoid coadministration

Renal impairment

  • Mild, moderate, or severe (CrCl ≥15 mL/min): No dosage adjustment required
  • End-stage renal disease (CrCl <15 mL/min): Avoid; not studied

Hepatic impairment

  • Mild or moderate (Child-Pugh A or B): No dosage adjustment required
  • Severe: Avoid

Dosing Considerations

Not indicated for prevention of migraine

Safety and efficacy not established

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Interactions

Interaction Checker

and rimegepant

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Nausea (2%)

            <1%

            Hypersensitivity, including dyspnea and severe rash

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            Warnings

            Contraindications

            History of hypersensitivity to rimegepant; delayed serious hypersensitivity reported

            Cautions

            Hypersensitivity

            • Hypersensitivity reactions, including dyspnea and rash, reported
            • Hypersensitivity reactions can occur days after administration, and delayed serious hypersensitivity has occurred
            • If a hypersensitivity reaction occurs, discontinue rimegepant and initiate appropriate therapy

            Drug interaction overview

            • Strong or moderate CYP3A4 inhibitors
              • Strong CYP3A4 inhibitors: Avoid coadministration; coadministration results in significant increase in rimegepant exposure
              • Moderate CYP3A4 inhibitors: If coadministered, avoid another dose of rimegepant within 48 hr
            • Strong or moderate CYP3A inducers
              • Avoid coadministration
              • Coadministration may result in significant reduction in rimegepant exposure and loss of efficacy
            • Inhibitors of P-gp or BCRP
              • Avoid coadministration
              • Coadministration may result in significant increase in rimegepant exposure
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            Pregnancy & Lactation

            Pregnancy

            Data are not available regarding the developmental risk associated with use in pregnant women

            Clinical considerations

            • Data suggest that women with migraine may be at increased risk of preeclampsia and gestational hypertension during pregnancy

            Animal studies

            • Oral administration during organogenesis resulted in adverse effects on development in rats (decreased fetal body weight and increased incidence of fetal variations) at exposures greater than those used clinically and which were associated with maternal toxicity

            Lactation

            Data are not available on the presence in human milk, effects on breastfed infants, or effects on milk production

            There are no animal data on the excretion of rimegepant in milk

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Calcitonin gene-related peptide (CGRP) receptor antagonist; binds to CGRP receptor, which is thought to be causally involved in migraine pathophysiology

            Absorption

            Bioavailability: 64%

            Peak plasma concentration: 1.5 hr

            Distribution

            Protein bound: 96%

            Vd: 120 L

            Metabolism

            Primarily metabolized by CYP3A4 and to a lesser extent by CYP2C9

            No major metabolites detected

            Elimination

            Half-life: ~11 hr (healthy subjects)

            Excretion

            • Primarily eliminated unchanged (77%)
            • Feces: 78% (42% unchanged)
            • Urine: 24% (51% unchanged)
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            Administration

            Oral Administration

            Use dry hands when opening blister pack

            Peel back foil covering of 1 blister and gently remove the orally disintegrating tablet (ODT); do not push the ODT through the foil

            As soon as the blister is opened, remove ODT and place on the tongue; alternatively, the ODT may be placed under the tongue

            ODT disintegrates in saliva so that it can be swallowed without additional liquid

            Take the ODT immediately after opening the blister pack; do not store ODT outside the blister pack for future use

            Storage

            Store at 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF)

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.