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CGRP Receptor Antagonist (Gepant — Migraine Prevention) Pregnancy: There are no adequate data on the developmental risk associated with use in pregnant women. In animal studies, oral administration of atogepant during organogenesis (rats and rabbits) or throughout pregnancy and lactation (rats) resulted in adverse developmental effects (decreased fetal and offspring body weight in rats; increased incidence of fetal structural variations in rabbits) at exposures greater than those used clinically. A pregnancy exposure registry monitors outcomes in women who become pregnant while taking the drug.

Atogepant

Brand names: Aquipta

An orally active calcitonin gene-related peptide (CGRP) receptor antagonist ('gepant') used for the preventive treatment of migraine in adults with frequent attacks.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Episodic migraine: 10 mg, 30 mg or 60 mg once daily. Chronic migraine: 60 mg once daily.
Route: Oral - taken with or without food
Frequency: Once daily
Max: No separate maximum is stated; the highest labelled dosage is 60 mg once daily
SOURCE: no UK SPC was fetched in this bundle (providers.emc is empty) - this draft is distilled from the US QULIPTA prescribing information (AbbVie Inc., label date 2025-09-30) and must be verified against the UK SPC. DOSAGE MODIFICATIONS FOR DRUG INTERACTIONS (episodic migraine / chronic migraine): strong CYP3A4 inhibitors 10 mg / 10 mg once daily; strong CYP3A4 inducers 60 mg once daily / not recommended; moderate CYP3A4 inducers 60 mg once daily / not recommended; weak CYP3A4 inducers 30 mg or 60 mg once daily / 60 mg once daily; OATP inhibitors 10 mg or 30 mg once daily / 30 mg once daily. Where the label marks co-administration as decreasing atogepant exposure (the inducers), monitor for reduced efficacy. No dosage adjustment is needed with concomitant moderate or weak CYP3A4 inhibitors. RENAL: severe renal impairment and end-stage renal disease (CLcr less than 30 mL/min) - episodic migraine 10 mg once daily; chronic migraine not recommended. GERIATRIC: population pharmacokinetic modelling suggests no clinically significant pharmacokinetic differences between elderly and younger subjects; clinical studies did not include sufficient numbers of patients aged 65 and over, and dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range. PAEDIATRIC: safety and effectiveness in paediatric patients have not been established. DOSAGE FORMS: tablets 10 mg, 30 mg and 60 mg.

Dose adjustments

Renal

Severe renal impairment and end-stage renal disease (creatinine clearance less than 30 mL/min): episodic migraine 10 mg once daily; chronic migraine - not recommended.

Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • History of hypersensitivity to atogepant or to any of the components of the product - reactions have included anaphylaxis and dyspnoea

Side effects

  • Nausea (most common adverse reaction, at least 4% and greater than placebo)
  • Constipation (most common adverse reaction, at least 4% and greater than placebo)
  • Fatigue/somnolence (most common adverse reaction, at least 4% and greater than placebo)
  • Hypersensitivity reactions including anaphylaxis, dyspnoea, rash, pruritus, urticaria and facial oedema - can occur days after administration; discontinue and institute appropriate therapy if they occur
  • Hypertension - development of new-onset hypertension and worsening of pre-existing hypertension have been reported post-marketing, may occur at any time but most frequently within 7 days of initiation, with some cases requiring drug treatment or hospitalisation
  • Raynaud's phenomenon - new-onset or worsening of pre-existing Raynaud's phenomenon may occur

Interactions

  • Strong CYP3A4 inhibitors (e.g. itraconazole) - significantly increase atogepant exposure; the recommended dosage is 10 mg once daily for both episodic and chronic migraine. No dosage adjustment is needed with moderate or weak CYP3A4 inhibitors
  • Strong CYP3A4 inducers (e.g. rifampicin) - significantly decrease atogepant exposure; episodic migraine 60 mg once daily with monitoring for reduced efficacy, chronic migraine not recommended
  • Moderate CYP3A4 inducers - episodic migraine 60 mg once daily; chronic migraine not recommended
  • Weak CYP3A4 inducers - episodic migraine 30 mg or 60 mg once daily; chronic migraine 60 mg once daily
  • OATP inhibitors - episodic migraine 10 mg or 30 mg once daily; chronic migraine 30 mg once daily

Clinical monograph

How it works

It blocks the CGRP receptor, antagonising the vasodilatory and pro-nociceptive actions of CGRP that are central to migraine pathophysiology.

Prescribing in practice

  • It should be reserved for migraine prophylaxis in line with NICE criteria, typically after previous preventive treatments have been unsuitable or ineffective.
  • Dose adjustment and caution apply with strong CYP3A4 inhibitors or inducers and in significant hepatic or renal impairment, so check current prescribing references.
  • Common adverse effects include nausea, constipation and fatigue, and response should be reviewed to confirm continued benefit.

Monitoring

No routine laboratory monitoring is required; monitor migraine frequency to assess response and review the need to continue after an adequate trial.

Counselling the patient

  • This medicine is taken regularly to prevent migraines, not to treat an attack in progress.
  • Report troublesome constipation, nausea, or tiredness.
  • Keep a headache diary to help judge whether it is working.

Evidence & guidelines

Use is supported by NICE technology appraisal guidance on atogepant for preventing migraine.

Reference: NICE TA913 (Atogepant for preventing migraine, 2024); ADVANCE trial (NEJM 2021); BASH UK Migraine Guidelines (2023); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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