Qulipta alternatives: What can I take instead of Qulipta?

In this article:

• Qulipta alternatives
• Nurtec
• Aimovig
• Ajovy
• Emgality
• Propranolol
• Natural alternatives
• How to switch

In this article

• Qulipta alternatives
• Nurtec
• Aimovig
• Ajovy
• Emgality
• Propranolol
• Natural alternatives
• How to switch

Qulipta (atogepant) is a brand-name prescription medication used to prevent migraine headaches (both chronic and episodic migraines). Currently, Qulipta is not available as a generic medicine. Qulipta is a type of calcitonin gene-related peptide (CGRP) receptor antagonist. Migraines are associated with increased levels of a protein called CGRP in the brain, and Qulipta helps to block CGRP receptors from being activated. As a result, pain and inflammation associated with migraine attacks can be alleviated. Qulipta is available as an oral tablet that is taken once daily.

RELATED: How much is Qulipta without insurance?

While an effective treatment for some people, Qulipta may not be the best and safest treatment for everyone for preventing migraines. The most common side effects of Qulipta are nausea, constipation, and fatigue. People should avoid or be cautious when using Qulipta if they have liver problems or kidney impairment. Those with high blood pressure (hypertension) are at risk of worsening high blood pressure while taking Qulipta. Some people may seek out a more convenient dosing schedule and prefer medications with less frequent dosing. Healthcare providers help make preventative treatment plans individualized from person to person, as everyone will have different medication needs and responses.

What can I take in place of Qulipta?

Other options are available for migraine prevention that do not improve with Qulipta. These alternative prescription medications include other CGRP receptor antagonists, certain beta blockers, certain antidepressants, certain blood pressure medications, and certain anti-seizure drugs. Due to their different uses, side effect profiles, dosages, and costs, these options may be more suitable for certain individuals.

Other alternatives to Qulipta

Other alternatives to Qulipta can help prevent migraines. Alternatives include oral prescription drugs used off-label for migraine prevention and injectable options given by a healthcare provider. Acute treatment of migraine can be useful for sudden migraine pain and is used as needed, such as triptans (like sumatriptan or eletriptan), Ubrelvy (ubrogepant), Zavzpret (zavegepant), or Reyvow (lasmiditan).

Oral prescription drugs:

• Amitriptyline
• Atenolol (Tenormin)
• Candesartan (Atacand)
• Lisinopril (Zestril)
• Nadolol
• Venlafaxine (Effexor XR)

Healthcare provider administered:

• Botox (OnabotulinumtoxinA)

Top 5 Qulipta alternatives

The following are some of the most common alternatives to Qulipta.

1. Nurtec

Nurtec (rimegepant) is a prescription medication used to treat and prevent migraine headaches. It is currently only available as a brand-name drug. Like Qulipta, Nurtec is an oral CGRP receptor antagonist. The American Headache Society states that CGRP receptor antagonists should be considered a first-line approach for migraine prevention as their efficacy, tolerability, and safety exceed those of any other preventive treatment approach. 

In a clinical study, participants assigned to receive Nurtec 75 mg every other day for twelve weeks had a greater reduction in migraine days per month than those assigned to placebo (4.3 fewer days versus 3.5 fewer days). Common side effects of Nurtec include nausea, indigestion, and abdominal pain. For migraine prevention, Nurtec is taken once every other day by mouth and is available as an oral disintegrating tablet (ODT). For acute migraine treatment, Nurtec is taken as needed at the first sign of migraine symptoms. Nurtec is a suitable alternative for people who would like to continue taking oral medication.

RELATED: Nurtec side effects and how to avoid them

2. Aimovig

Aimovig (erenumab) is a brand-name injectable CGRP receptor antagonist medication that is recommended for preventing both episodic and chronic migraines. This alternative comes in an auto-injector containing the medication in solution form that is injected under the skin in the abdomen, thigh, or upper arm. Aimovig was the first ever FDA-approved CGRP receptor antagonist in 2018. Clinical studies have shown that at a monthly dose of 70 mg or 140 mg, Aimovig significantly reduced migraine frequency, the effects of migraines on daily activities, and the use of acute migraine-specific medication over six months. 

Aimovig is generally well-tolerated and safe. This alternative is conveniently only administered once a month, and a healthcare provider will provide proper training prior to using it at home. Like Qulipta, Aimovig may cause hypertension, so it’s recommended to monitor for the onset or worsening of hypertension. Aimovig is a well-suited alternative for those who have not responded to other migraine prevention treatments and are tolerant of injections.

RELATED: How to save on Aimovig

3. Ajovy

Ajovy (fremanezumab) is another brand-name injectable CGRP receptor antagonist medication that is recommended for episodic and chronic migraine prevention. Ajovy comes in two different subcutaneous (administered under the skin) forms: an auto-injector and a prefilled syringe. This alternative has two convenient dosing options: once a month or every three months. Ajovy has shown long-term efficacy in trials demonstrating that both Ajovy quarterly and monthly were well tolerated and sustained improvements in monthly migraine days, headache days, and headache-related disability for up to twelve months in patients with migraine. The most common side effect of Ajovy and other injectable CGRP receptor antagonists is injection-site reactions like pain and redness. Ajovy may be suitable for those who prefer less frequent dosing and are comfortable with injections.

4. Emgality

Emgality (galcanezumab) is the third injectable CGRP receptor antagonist medication used to help prevent episodic and chronic migraines. Emgality also has a unique dose approved for preventing cluster headaches, a rare and severe type of headache. This injectable alternative is available as an auto-injector and a prefilled syringe. After an initial loading dose (higher starter dose), Emgality is dosed once a month. A clinical trial evaluating people who have failed at least two to four other migraine preventative drug categories found Emgality was safe and well tolerated. It concluded that Emgality is an important treatment option for those who have not benefited from or tolerated previous standard-of-care treatments.

5. Propranolol (Inderal LA)

Propranolol is a generic prescription medication available in extended-release formulation (Inderal LA) and immediate-release formulation. Propranolol is a beta blocker that can be used to prevent migraines, along with several other uses such as hypertension, angina (chest pain associated with coronary artery disease), cardiac arrhythmias, tremor, and to reduce death post-heart attack. Beta blockers like propranolol are about 50% effective in producing a greater than 50% reduction in migraine attack frequency. 

Propranolol is available as an oral tablet and capsule, depending on the formulation. The extended-release formulation is taken once a day, and the immediate-release formulation is taken two to three times a day. Beta blockers like propranolol have many common side effects, such as dizziness, tiredness, low blood pressure (hypotension), and a change in heart rate. It’s important to know that it can take several weeks to notice headache improvement with beta blockers. This may be a suitable alternative for people who have not responded to other migraine medications.

RELATED: Propranolol side effects, interactions, and how to avoid them

Natural alternatives to Qulipta

Alternative remedies are an important part of migraine prevention. A variety of migraine and headache guidelines from clinical organizations recommend education and lifestyle modifications that can improve the quality of life for those with migraines.

The American Headache Society stresses the importance of migraine treatment plans, which include identifying and minimizing exposure to migraine triggers, proper nutrition, regular exercise, adequate hydration, proper sleep, stress management, and a migraine diary. Common migraine triggers include changes in sleep schedule, dehydration, hormone changes, stress, an increase in caffeine or alcohol intake, weather changes, and certain smells.

Supplements, such as magnesium oxide, may also be considered for migraine prevention. The American Migraine Foundation considers magnesium oxide supplements a reasonable prevention option for people with a history of aura (visual or sensory disturbances associated with migraines) and migraines related to menstruation. This supplement is available in several oral pill forms, like tablets and capsules, and the usual dose for migraine prevention is 400 mg to 600 mg per day.

How to switch to a Qulipta alternative

1. Discuss all health conditions with a healthcare provider

Before switching from Qulipta to an alternative, the healthcare provider must be aware of all medical conditions. Some alternatives should be used with caution or avoided with certain medical conditions.

2. Do not suddenly stop taking Qulipta without medical advice

While Qulipta can be safely discontinued and is not believed to cause withdrawal effects, it’s important for a migraine prevention plan to be established to avoid a sudden increase in migraines. If the healthcare provider has been consulted and decided that stopping the medication is appropriate, Qulipta can be safely stopped.

3. Discuss all prescription and over-the-counter medications with a healthcare provider

Before switching from Qulipta to an alternative, the healthcare provider must review a complete medication list, including prescription drugs, over-the-counter (OTC) medications, and supplements. Certain alternatives have dangerous drug interactions that should be avoided.

4. Continue to improve lifestyle changes and avoid migraine triggers

Following lifestyle changes and continuing to avoid migraine triggers are important for people treating and preventing migraines. Healthcare providers and pharmacists can advise on migraine prevention and provide resources for migraine diaries.