CGRP receptor antagonist (gepant) Pregnancy: There are no adequate data on the developmental risk associated with use in pregnant women; in animal studies oral administration during organogenesis caused adverse developmental effects in rats at exposures greater than clinical and associated with maternal toxicity. A pregnancy exposure registry exists (US label §8.1).

Rimegepant

Brand names: Vydura

Rimegepant is an orally administered calcitonin gene-related peptide (CGRP) receptor antagonist (a 'gepant') used for the acute treatment and prevention of migraine.

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: 75 mg as a single dose, taken as needed for the acute treatment of migraine

Route: Oral — orally disintegrating tablet (ODT) placed on the tongue or under the tongue; disintegrates in saliva and can be swallowed without additional liquid

Frequency: As needed for an acute attack; maximum one dose in a 24-hour period

Max: 75 mg in any 24-hour period. The safety of using more than 18 doses in a 30-day period has not been established.

SOURCE CAVEAT: no UK SPC posology was fetched in this bundle — the dose above is from the US FDA prescribing information for NURTEC ODT and must be verified against the UK SPC. Preventive treatment of episodic migraine: 75 mg taken orally every other day (§2.2). Administration: use dry hands, peel back the foil of one blister (do not push the tablet through the foil), take immediately after opening, do not store outside the blister for future use. Avoid concomitant administration with strong CYP3A4 inhibitors. Avoid another dose within 48 hours when given with a moderate CYP3A4 inhibitor or with a potent P-gp inhibitor. Avoid concomitant administration with strong or moderate CYP3A inducers (may lead to loss of efficacy). Elderly: no clinically significant pharmacokinetic differences were observed, but clinical studies did not include sufficient numbers of patients aged 65 and over. Paediatric: safety and effectiveness in paediatric patients have not been established.

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 reaction to rimegepant, NURTEC ODT, or any of its components — reactions have included anaphylaxis and delayed serious hypersensitivity

Side effects

Nausea (reported in >=1% of patients treated for acute migraine)
Abdominal pain / dyspepsia (preventive treatment, reported in >=2% and >=1% higher than placebo)
Serious hypersensitivity reactions including anaphylaxis, dyspnoea and rash — can occur days after administration
New-onset or worsening of pre-existing hypertension (postmarketing; some cases required drug treatment or hospitalisation)
New-onset or worsening of pre-existing Raynaud's phenomenon

Interactions

Strong CYP3A4 inhibitors — avoid concomitant administration (significant increase in rimegepant exposure)
Moderate CYP3A4 inhibitors — avoid another dose of rimegepant within 48 hours
Strong and moderate CYP3A inducers — avoid concomitant administration (significant reduction in exposure, may lead to loss of efficacy)
Potent P-gp inhibitors — avoid another dose of rimegepant within 48 hours

Clinical monograph

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.

Reference: NICE TA919; 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