Ubrelvy For Acute Migraine Treatment. 2024
The Migraine process in the brain release 3 neurochemicals-Neurokinan A, Substance P, and CGRP. From the experience with CGRP drugs for Migraine prevention, it is very clear that the neurochemical CGRP has a lot to do with Migraine treatment.
Now that we know that modulating CGRP works well for Migraine prevention, there is a need for a CGRP drug that works for acute Migraine therapy.
Read my Mini Migraine Book Here.
This is an article by Britt Talley Daniel MD, member of the American Academy of Neurology, Migraine textbook author, and blogger.
In 2020 the FDA approved Ubrelvy (ubrogepant) for acute treatment of Migraine with and without aura. Ubrelvy provides freedom from headache pain at 2 hours. It has few side effects and can be used for patients who have contraindications for taking triptans.
Related questions
What is the indication for Ubrelvy (Ubrogepant)?
Ubrelvy (Ubrogepant) is a calcitonin gene-related peptide, CGRP, receptor antagonist for the acute treatment of Migraine with or without aura in adults. It is not indicated for the preventive treatment of Migraine.
And as for Migraine with aura, read my article on this at doctormigraine.com by clicking here.
What drugs should not be used with Ubrelvy (Ubrogepant)?
Drugs that are contraindicated are the strong CYP3A4 inhibitors--ketoconazole, itraconazole, and clarithromycin.
What are the common reported adverse reactions?
Adverse reactions are nausea, dry mouth, and somnolence.
What is the dosage and administration of Ubrelvy (Ubrogepant)?
The recommended dose is a 50 or 100 mg tablet taken at onset of Migraine headache. The 50 mg dose should be first tried, while a second 50 mg dose may be given 2 hours after the initial dose. The maximal dose for a 24-hour period is 200 mg.
This type of medication is called “a gepant” in the neurology headache literature.
Are there special medical populations who have contraindications for use?
Pregnancy--There are no adequate data on the developmental risk associated with the use of Ubrelvy (Ubrogepant) in pregnant women.
Lactation--There are no data on the presence of ubrogepant in human milk, the effects of ubrogepant on the breastfed infant, or the effects of ubrogepant on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for Ubrelvy and any potential adverse effects on the breastfed infant from Ubrelvy or from the underlying maternal condition.
Pediatric Use--Safety and effectiveness in pediatric patients have not been established.
Geriatric Use--In pharmacokinetic studies, no clinically significant pharmacokinetic differences were observed between elderly and younger subjects.
Are there medical illness limited use for Ubrelvy?
Hepatic impairment—No dose adjustment is recommended for patients with mild or moderate hepatic impairment. Dose adjustment for is recommended for patients with severe hepatic impairment.
Renal impairment--No dose adjustment is recommended for patients with mild or moderate renal impairment. Dose adjustment is recommended for patients with severe renal impairment
Benefit of Ubrelvy for acute Migraine therapy.
Specialty medications like triptans are used by only about a quarter of patients for Migraine treatment. This low use of available, generic, effective drugs for Migraine is shameful. Use of triptans is limited by insurance coverage, expense, and lay misinformation of possible triptan side effects.
These side effects are --chest tightness or pressure, near fainting, neck/back pain which may be burning, warm or hot, dizziness, or drowsiness. Unfortunately, these symptoms sometimes limit triptan use.
Another problem with triptans is that they cause vasoconstriction of arteries and thus, they are contraindicated with uncontrolled hypertension, angina, coronary artery disease, previous heart attack, or stroke.
Ubrelvy (Ubrogepant) has no affect of vasoconstriction and is okay with heart or stroke conditions.
Also, triptans successfully treat migraine in 70-80% of patients and the gepant, Ubrelvy (Ubrogepant), may help this 20-30% population of poorly triptan treated patients.
Comments from American Headache Specialists.
Richard Lipton MD, a co-author of the study mentioned here on Ubrogepant and director of the Montefiore Headache Center at Albert Einstein College Medicine stated:
“Triptans activate serotonin receptors and constrict blood vessels., Explained Dr. Lipton, who is also professor and vice chair of neurology. “Gepants block CGRP receptors and do not constrict blood vessels. They will be most useful in people who do not respond to triptans and, have side effects limiting triptan use (triptan sensations such as chest pressure, diaphoresis, flushing), or who have cardiovascular contraindications or precautions restricting the use of triptans and these include cardiovascular events such as myocardial infarction and stroke, cardiovascular conditions such as angina, claudication or ischemic colitis, or multiple cardiovascular risk factors. The side effects of gepants looks very favorable.”
Kathleen B. Digre MD, Professor of neurology and ophthalmology and chief of the division of headache and neuro- ophthalmology at the University of Utah School of Medicine and current president of the American Headache Society, said the expected upcoming addition of ubrogepant to the neurologist armamentarium opens up new targets for us to be treating patients,” and hailed the therapy as “another designer drug for migraines. Altogether, the variety of new drugs for migraine treatment means I’ve got more tools in my box and I ever have”
Andrew D. Hershey, MD, PhD endowed chair and director of the Headache Center and division of neurology at Cincinnati Children’s Hospital Medical Center said “ubrogepants presents a new class of acute treatment for headaches in patients with migraine. Although CGRP antagonists have demonstrated efficacy compared to placebo, it is not known what role they will play, compared with triptans and over-the-counter remedies, largely nonsteroidal and anti-inflammatory drugs.” Dr. Hershey said.
Stuart J. Tepper, MD, professor of neurology at the Giesel School of medicine at Dartmouth and director of the Dartmouth Headache Center said, “the advantage of this drug and its cousin (rimegepant) is the side effect are really minimal. Those of us in headache medicine are comfortable and are ready for FDA approval. He said that in his practice hardly any patients would have contraindications to the gepants class of drugs. In fact, he suspected ubrogepant could work even better in real life than in the trial because patients may take it early in a migraine attack.
Yulia Orlova, MD, PhD, a headache specialist and assistant professor of neurology at the University of Florida College of Medicine in Gainesville said, “with migraine being a chronic disorder characterized by recurrent headaches, the study based on a single attack could not adequately validate the drug’s safety and frequent use over an extensive period. Earlier generations of drugs used to treat an acute migraine attack posed the challenge of medication overuse headache (also known as rebound headache) when taken too frequently. It will take some time before we can answer the question if ubrogepant also carries the risk of medication overuse headache. In the meantime, we will still need to be very vigilant if patients will be taking this medication very often and for a longer period of time.”
Summary
Ubrelvy is an exciting development in Migraine treatment options. Now headache specialists have another arrow in their quiver for treating Migraine.
Check out my Big Book on Migraine Here.
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All the best.
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Britt Talley Daniel MD
