Rimegepant

How it works

It blocks the CGRP receptor, antagonising the vasodilatory and pro-nociceptive effects of CGRP that are implicated in migraine pathophysiology.

Prescribing in practice

• Hypersensitivity reactions, including dyspnoea and rash, can occur and may be delayed by days, so patients should be advised to seek help if these develop.
• Its metabolism is affected by CYP3A4 and P-glycoprotein, so co-administration with strong inhibitors or inducers of these pathways should be avoided.
• Use is not recommended in severe hepatic impairment or end-stage renal disease.

Monitoring

No routine laboratory monitoring is required; instead assess migraine frequency and severity and review for hypersensitivity reactions.

Counselling the patient

• The orally disintegrating tablet is placed on or under the tongue and allowed to dissolve without water.
• Seek medical attention if a rash, facial swelling or breathing difficulty develops, even some days after a dose.
• Keep a record of migraine frequency to help judge whether the treatment is working.

Evidence & guidelines

Rimegepant's efficacy for acute and preventive migraine treatment was established in randomised placebo-controlled trials, and it is recommended by NICE for eligible patients.