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Rimegepant Orally Disintegrating Tablet (Nurtec ODT)

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The Food and Drug Administration has approved the second oral, non-peptide, small molecule, calcitonin gene-related peptide (CGRP) receptor antagonist, following ubrogepant, for acute migraine. Rimegepant is the first quick-dissolving tablet approved for this indication. It received a priority review and is marketed as Nurtec ODT.

INDICATIONS

Rimegepant should be prescribed to treat acute migraine with or without aura in adults. 1

DOSAGE

The recommended dose is 75 mg placed on or under the tongue as needed. 1 No water is needed. The maximum dose is one tablet in a 24-hour period. The safety of treating more than 15 migraines that occur in a 30-day period has not been established. 1 Rimegepant is available as 75 mg orally disintegrating tablets (ODT).

POTENTIAL ADVANTAGES

Rimegepant is a quick-dissolving tablet that does not require water for administration. It may onset faster vs. ubrogepant. Rimegepant also has a long elimination half-life (approximately 11 hours) vs. five to seven hours for ubrogepant. 1,2 This may contribute to a longer duration of action.

POTENTIAL DISADVANTAGES

Rimegepant is a substrate of CYP3A4 as well as transporters P-gp and breast cancer-resistant protein (BCRP); thus, avoid using with strong CYP3A4 inhibitors, strong and moderate CYP3A4 inducers, and inhibitors of P-gp or BCRP. 1

COMMENTS

The efficacy of rimegepant was evaluated in a randomized, double-blind, placebo-controlled trial. 1,3 Adult subjects with at least a one-year history of migraine, with or without aura, were randomized to rimegepant 75 mg (n = 732) or placebo (n = 734). Subjects were instructed to treat a migraine of moderate to severe headache pain intensity. The coprimary endpoints were percent with freedom from pain and freedom from the most bothersome symptoms (MBS), such as nausea, phonophobia, or photophobia, at two hours postdose. Pain relief was defined as a reduction in migraine pain from moderate or severe...