Anti-CGRP monoclonal antibody (IV) Pregnancy: There are no adequate data on developmental risks associated with use in pregnant women. No adverse developmental effects were observed following administration to pregnant animals at doses greater than those used clinically. A pregnancy exposure registry monitors outcomes in women exposed during pregnancy. Published data suggest women with migraine may be at increased risk of pre-eclampsia and gestational hypertension during pregnancy (US labelling §8.1).

Eptinezumab

Brand names: Vyepti

Eptinezumab is a humanised monoclonal antibody given by intravenous infusion for the prophylaxis of migraine in adults who have 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: 100 mg; some patients may benefit from 300 mg

Route: Intravenous infusion over approximately 30 minutes — must be diluted before use; for intravenous infusion only, never as an intravenous push or bolus injection

Frequency: Every 3 months

No UK SPC (eMC) record was fetched in this bundle — figures are from the US prescribing information for VYEPTI (Lundbeck, label date 2026-06-05) and must be verified against the UK SPC before use. Indication is preventive treatment of migraine. DILUTION: dilute only in 100 mL of 0.9% Sodium Chloride Injection, USP, in an infusion bag made of polyvinyl chloride, polyethylene or polyolefin, using aseptic technique. For a 100 mg dose withdraw 1 mL from a single-dose vial and inject it into the 100 mL bag; for a 300 mg dose withdraw 1 mL from each of 3 single-dose vials and inject the resulting 3 mL into the 100 mL bag. Single-dose vials contain no preservative — discard any unused portion. Gently invert to mix completely; do not shake. Once diluted the solution must be infused within 8 hours, stored at room temperature 20-25 degrees C during that time; do not freeze. ADMINISTRATION: inspect visually for particulate matter and discoloration and do not use if the liquid contains visible particulate matter or is cloudy or discoloured; no other medications should be administered through the infusion set or mixed with the product; use an intravenous infusion set with a 0.2 micron or 0.22 micron in-line or add-on sterile filter; after the infusion is complete flush the line with 20 mL of 0.9% Sodium Chloride Injection, USP. PAEDIATRIC: safety and effectiveness in paediatric patients have not been established — verify any under-18 use against a children's formulary.

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

Serious hypersensitivity to eptinezumab or to any of the excipients — reactions have included anaphylaxis and angioedema

Side effects

Nasopharyngitis (most common, at least 2% and 2% or more above placebo)
Hypersensitivity (most common, at least 2% and 2% or more above placebo)
Hypersensitivity reactions including anaphylaxis and angioedema — a labelled warning
Constipation with serious complications — a labelled warning
Hypertension and Raynaud's phenomenon — labelled warnings

Clinical monograph

How it works

It binds to calcitonin gene-related peptide (CGRP) ligand, preventing it from activating its receptor and thereby reducing the neurovascular signalling that drives migraine.

Prescribing in practice

Hypersensitivity reactions, including anaphylaxis and angioedema, can occur during or shortly after the infusion, so administer where reactions can be managed and observe the patient.
It is reserved for patients with frequent migraine in whom other preventive treatments have been unsuitable or ineffective, in line with NICE-recommended use.
Review benefit after an adequate treatment period and stop if there is no worthwhile reduction in migraine frequency.

Monitoring

No routine laboratory monitoring is required, but headache frequency should be tracked to assess response and patients observed for infusion-related reactions.

Counselling the patient

This treatment aims to reduce how often you get migraines rather than to treat an individual attack.
Tell the clinician straight away if you develop rash, swelling or breathing difficulty during or after the infusion.
Keep a headache diary so we can judge whether the treatment is working.

Evidence & guidelines

NICE has appraised CGRP-targeted antibodies for migraine prophylaxis, and pivotal trials demonstrated reductions in monthly migraine days compared with placebo.

Reference: NICE TA871; ABN migraine; BASH; SmPC; 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).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways