Nurtec (rimegepant) alternatives: What can I take instead of Nurtec?

Nurtec (rimegepant) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) used to treat and prevent migraine headaches. This medication is currently only available as a brand-name medicine. Nurtec belongs to the drug class called calcitonin gene-related peptide (CGRP) receptor antagonists. Migraine attacks are associated with raised levels of a protein called CGRP in the brain, and Nurtec works by blocking CGRP receptors from being activated. These medications can also help stop the pain signals, swelling of blood vessels, and inflammation that occurs in the brain. As a result, people can experience pain relief and improved migraine symptoms. Nurtec is an orally disintegrating tablet (Nurtec ODT) that dissolves on or under the tongue.

While an effective treatment for some people, Nurtec may not be the best and safest migraine treatment for everyone. People with liver problems or end-stage kidney disease should avoid using Nurtec. Some people may experience better migraine relief with other treatment options or prefer medications with less frequent dosing or side effects.

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What can I take in place of Nurtec?

There are other options available to treat and prevent migraines that do not improve with Nurtec. These alternative prescription medications include other CGRP receptor antagonists, triptans, and ergots. Additionally, prescription and over-the-counter (OTC) pain relievers can be effective for some people. While Nurtec has FDA approval to treat and prevent migraines, it is important to note that alternative medications may either only treat or only prevent migraines, so it is best to check what type of therapy is needed. These options may be more suitable for certain individuals due to their different uses, side effect profiles, dosages, and costs.

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Other alternatives to Nurtec

Other alternatives to help with the treatment of migraines include prescription and OTC pain relievers that may be useful for milder cases. Some of these options include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and caffeine. OTC medicines do not require a prescription. Ergot medications are another alternative option that are associated with higher risks and side effects.

Prescription migraine pain relievers:

• Cambia (diclofenac)
• Elyxyb (celecoxib)
• Esgic (butalbital, acetaminophen and caffeine)
• Fioricet (butalbital, acetaminophen and caffeine)

Over-the-counter migraine pain relievers:

• Tylenol (Acetaminophen)
• Aspirin
• Excedrin (acetaminophen, aspirin, and caffeine)
• Advil (ibuprofen)
• Aleve (naproxen)

Ergots:

• Ergomar (ergotamine)
• Migranal (dihydroergotamine)
• Trudhesa (dihydroergotamine)

Ditans

• Reyvow (lasmiditan)

Top 5 Nurtec alternatives

The following are some of the most common alternatives to Nurtec. Of note, alternative medications may either only treat or prevent migraines, so it is best to check what type of therapy is needed when considering alternative medications.

1. Triptans

Triptan medications are the preferred treatment for moderate to severe migraine attacks. Triptans have established efficacy in treating migraines. If a person has an insufficient response to one triptan, there may be a benefit from trying a second triptan or a different migraine therapy.

The safety of triptans is well established. However, some people should avoid taking these medications, including people with contraindications such as known or suspected coronary artery or cerebrovascular disease, because they might increase the risk of heart attack or other cardiac or cerebrovascular events. Triptans are taken at the first sign of a migraine attack, and the dose can typically be repeated in at least 2 hours from the initial dose. However, following the directions provided on the prescription bottle is important, as some triptans may have different dosing recommendations. These medications are suitable alternatives for people who have not had luck with Nurtec and do not have coronary artery or cerebrovascular disease.

Examples of triptans include: Eletriptan, frovatriptan, rizatriptan, sumatriptan (available by mouth, nasal spray, or subcutaneous injection), the combination of sumatriptan and naproxen and zolmitriptan (available by mouth or nasal spray).

2. Ubrelvy (ubrogepant)

Ubrelvy is another CGRP receptor antagonist, similar to Nurtec (gepants). However, Ubrelvy is only used to treat migraine attacks. In clinical trials, Ubrelvy has demonstrated good safety and tolerability. The most common side effects are nausea, drowsiness, and dry mouth. Additionally, studies showed no evidence of medication-overuse headache, hepatotoxicity (liver injury), or serious adverse effects. Nurtec and Ubrelvy are each suggested treatments for moderate to severe migraine attacks. Nurtec is available as a tablet taken by mouth as a single dose at the first sign of a migraine attack and can be repeated after at least 2 hours if needed for symptoms that persist. Ubrelvy is a well-suited alternative for people who have not responded to Nurtec and would like to continue taking medication by mouth.

3. Qulipta (atogepant)

Qulipta is another type of CGRP receptor antagonist, similar to Nurtec. However, Qulipta is only used to prevent migraines (both chronic and episodic migraines). Clinical studies demonstrated that Qulipta significantly reduced monthly migraine days, monthly headache days, and monthly medication use days. The most commonly reported side effects are nausea, constipation, drowsiness, and weight loss. Qulipta is a suggested treatment option for preventing migraines. This alternative is available as a tablet taken by mouth once daily. Qulipta is a suitable alternative for people who have not responded to Nurtec for migraine prevention and would prefer taking medication by mouth.

4. Injectable CGRP Receptor Antagonists

Injectable CGRP receptor antagonist medications are recommended for preventing both episodic and chronic migraines. Overall, these alternatives are efficacious, well-tolerated, and safe. In clinical studies, each injectable CGRP receptor antagonist resulted in statistically significant reductions in monthly migraine days. The most common side effects include injection site reactions such as itchiness, pain, or redness. These alternatives are either auto-injectors or prefilled syringes containing the medication in solution form and are injected under the skin in the abdomen, thigh, or upper arm. Injectable CGRP receptor antagonists are well-suited alternatives for people who have not responded to other migraine prevention treatments and are generally tolerant of injections.

Examples of injectable CGRP receptor antagonists include: Aimovig, Ajovy, and Emgality

5. Zavzpret (zavegepant)

Zavzpret is another type of CGRP receptor antagonist, similar to Nurtec. However, Zavzpret is only used to treat migraine attacks. Unlike Nurtec, Zavzpret is a nasal spray administered as one spray in one nostril as a single dose at the first sign of a migraine attack. The most common side effects include taste disorder (changes in taste), nausea, and nasal discomfort. As a relatively newer acute treatment option, Zavzpret is a suitable option for people who prefer non-oral medication due to nausea or vomiting during a migraine.

Natural alternatives to Nurtec

Alternative remedies for Nurtec include the supplement magnesium and lifestyle changes.

Magnesium oxide is a supplement that may be used for preventive treatment of migraines. The American Migraine Foundation states magnesium oxide is considered 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 tablet form, and the usual dose for migraine prevention is 400 mg to 600 mg per day.

Recommended lifestyle changes include avoiding migraine triggers. Learning and avoiding migraine triggers is key to preventing migraines. Some possible triggers include stress, changes in sleep schedule, hormone changes, increase in caffeine or alcohol intake, weather changes, dehydration, and certain smells.

Additional lifestyle changes include staying hydrated, maintaining regular exercise, learning relaxation techniques, and eating regularly scheduled meals. Some fast and easy home remedies for migraines that come on quickly include resting in a quiet and darkened room, napping, placing an ice pack on the forehead, and drinking lots of fluid.

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How to switch to a Nurtec alternative

1. Discuss all health conditions with a healthcare provider

Before switching from Nurtec to an alternative, it’s important the healthcare provider is aware of all medical conditions. Some alternatives should be used with caution or avoided with certain medical conditions.

2. Do not suddenly stop taking Nurtec without medical advice

Only stop taking Nurtec if the healthcare provider has been consulted and decided stopping the medication is appropriate. While Nurtec can be safely discontinued and is not believed to cause withdrawal effects, it’s important for a migraine treatment or prevention therapy plan to be established.

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

Before switching from Nurtec to an alternative, it’s important that the healthcare provider reviews a complete medication list, including prescription drugs and OTC medications. Some alternatives have dangerous drug interactions that must be avoided.

4. Continue to improve lifestyle and diet changes for managing migraines

It’s important for people treating and preventing migraines to follow lifestyle changes and continue to avoid migraine triggers. Healthcare providers and pharmacists can give advice for migraine prevention and treatment.