A gepant for migraine
Rimegepant
An oral melt tablet that both treats an acute migraine and, taken every other day, helps prevent attacks.
What is Rimegepant?
Rimegepant (brand name Vydura) is a newer oral medicine called a gepant, which works by blocking CGRP, a natural body chemical involved in migraine. It is unusual because it can do two jobs: a single melt-in-the-mouth tablet can treat a migraine attack that has started, and, taken every other day, it can also help prevent migraines. It is generally well tolerated, with nausea being the most common side effect. As a newer class, gepants are often used when older medicines have not suited a person, and they are not recommended in pregnancy without advice.
Education and reference only. This is a plain-language guide to Rimegepant — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Rimegepant is a gepant, a newer type of tablet that blocks CGRP (calcitonin gene-related peptide), a body chemical that plays a key part in migraine. It comes as a tablet that dissolves on the tongue, which is helpful when nausea makes swallowing difficult. It is unusual in that it can be used in two ways: as an acute treatment, taken when a migraine starts to relieve the attack, and as a preventer, taken on alternate days to reduce how often migraines happen. In the UK it is generally used by people whose migraines have not been well controlled by older options.
How it works
CGRP rises during a migraine and helps drive the pain and other symptoms. Rimegepant blocks the place where CGRP acts, which can both calm an attack that has already begun and, when taken regularly, make attacks less frequent. This dual action is what makes it different from many other migraine medicines: as an acute treatment it works on the attack in front of you, while as a preventer taken every other day it works gradually to reduce future attacks. Unlike triptans, gepants do not narrow blood vessels.
Company & origin
Originated / developed by: Pfizer.
A newer oral medicine used in the UK both to treat a migraine attack and, taken regularly, to help prevent migraine.
What it treats
Conditions Rimegepant is used for
Practical use
How to take Rimegepant
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- To treat an attack, place one melt tablet on your tongue and let it dissolve as soon as the migraine starts.
- To prevent migraines, take it every other day, on the schedule your prescriber gives you.
- Be clear with your prescriber whether you are using it to treat attacks, to prevent them, or both, and do not overuse it.
- It dissolves on the tongue without water, which is useful if nausea makes swallowing difficult.
- Tell your prescriber if you are pregnant, planning a pregnancy or breastfeeding, as it is not recommended without advice.
Weighing it up
Advantages & disadvantages of Rimegepant
Advantages
- Can both treat a migraine attack and, taken every other day, help prevent migraines.
- A melt-in-the-mouth tablet that does not need water, which helps when nausea is present.
- Does not narrow blood vessels, so it may suit some people who cannot take triptans.
Disadvantages
- As a newer medicine, it is often used after older options and may not always be readily available.
- It can cause nausea in some people.
- It must be used carefully, with a clear plan for whether it is for treating attacks or preventing them.
Practical use
Good to know
It helps to understand the difference between acute treatments and preventers: rimegepant is unusual because it can be both, depending on how it is used. Taken when a migraine starts, it treats that attack; taken every other day, it helps prevent attacks. Your prescriber will be clear about which way you are using it, as it should not be overused. Because it does not narrow blood vessels, it can be an option for some people who cannot take triptans for heart-related reasons, though this should always be checked with your prescriber. The melt-in-the-mouth tablet is handy when nausea makes swallowing hard. It is generally well tolerated, with nausea the most common effect, and it is not recommended in pregnancy without advice.
Who should not take it / use with caution
- It is not recommended in pregnancy without advice, and should be discussed before planning a pregnancy or while breastfeeding.
- People who have had a serious allergic reaction to rimegepant or its ingredients should not use it.
- It is used with care in people with significant liver problems, who should tell their prescriber.
Monitoring
- Reviewing whether it is helping, and how often it is being used, to avoid overuse.
- Checking liver health if there are existing liver problems.
- Discussing pregnancy plans, breastfeeding and overall migraine control at review.
Side effects
- Nausea is the most common side effect.
- Some people get tummy upset or indigestion.
- Rarely, an allergic reaction such as rash or swelling can occur, which needs medical attention.
Key interactions
- Certain medicines that affect how the liver handles drugs can change rimegepant levels, so tell your prescriber what you take.
- It is best not to combine it too closely with other CGRP-blocking medicines without advice.
- Always mention other migraine treatments so your overall plan can be balanced and overuse avoided.
Available as: A melt-in-the-mouth tablet taken by mouth without water.
Answers
Rimegepant: frequently asked questions
Can rimegepant both treat and prevent migraine?
Yes, unusually it can do both: taken when an attack starts it treats that migraine, and taken every other day it helps prevent migraines.
Do I need water to take it?
No. It is a melt-in-the-mouth tablet that dissolves on your tongue, which is helpful when nausea makes swallowing difficult.
Can I take it if I cannot take triptans?
Possibly. Unlike triptans it does not narrow blood vessels, so it may suit some people who cannot take them, but always check with your prescriber.
What is the most common side effect?
Nausea is the most common side effect, and it is otherwise generally well tolerated.
Is it safe in pregnancy?
It is not recommended in pregnancy without advice, so discuss it if you are pregnant, planning a pregnancy or breastfeeding.
Authoritative sources
- BNF
- NICE CKS
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