{"id":631909,"date":"2025-04-10T18:41:13","date_gmt":"2025-04-10T22:41:13","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=631909"},"modified":"2025-04-10T18:41:13","modified_gmt":"2025-04-10T22:41:13","slug":"nurtec-interactions","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/nurtec-interactions\/","title":{"rendered":"Nurtec interactions to avoid"},"content":{"rendered":"

Nurtec<\/span><\/a> (<\/span>rimegepant<\/span>) is an <\/span>orally disintegrating tablet<\/span> prescription drug<\/span> and a member of the <\/span>calcitonin gene-related peptide<\/span> (<\/span>CGRP<\/span>) <\/span>receptor antagonists<\/span><\/a>, sometimes called gepants. It is manufactured by <\/span>Pfizer<\/span> and is approved by the <\/span>Food and Drug Administration<\/span> (<\/span>FDA<\/span>) for both the <\/span>prevention and <\/span>acute treatment of migraines<\/span><\/a> with or without aura. Nurtec and other gepants are substrates of CYP <\/span>enzymes<\/span> and drug transporters, which translates to a high potential for <\/span>drug interactions<\/span>. Nurtec specifically is a major substrate of the isoenzyme <\/span>CYP3A4<\/span> and drug transporter P-glycoprotein, so use with other medications and certain foods that inhibit or induce this specific <\/span>enzyme<\/span> or drug transporter can particularly impact the metabolism of Nurtec. Such medications include those for migraines, antimicrobials, and <\/span>over-the-counter<\/span> products like <\/span>St. John\u2019s wort<\/span> and <\/span>grapefruit juice<\/span>. It\u2019s important to be aware of Nurtec interactions, as concomitant use with certain drugs and foods can affect Nurtec\u2019s effectiveness or cause adverse effects.\u00a0<\/span><\/p>\n

Nurtec <\/span>drug interactions<\/span><\/h2>\n

The most concerning <\/span>drug interactions<\/span> that can occur with Nurtec are when it is taken with strong <\/span>CYP3A4<\/span> or P-glycoprotein <\/span>inhibitors<\/span> or <\/span>inducers<\/span>.\u00a0<\/span><\/p>\n

CYP3A4<\/span> inhibitors<\/span><\/h3>\n

Strong <\/span>CYP3A4<\/span> inhibitors<\/span> encompass a broad grouping of medications. <\/span>CYP3A4<\/span> inhibitors<\/span> interact with Nurtec by preventing the metabolism of the active ingredient, <\/span>rimegepant<\/span>. The <\/span>prescribing information<\/span> for <\/span>Nurtec ODT<\/span> recommends avoiding co-administration of these medications as it is expected the <\/span>CYP3A4<\/span> inhibitors<\/span> will decrease the metabolic elimination of <\/span>rimegepant<\/span> and increase the risk of toxicity.\u00a0<\/span><\/p>\n

One <\/span>study of 22 healthy volunteers <\/span><\/a>demonstrated that coadministration of <\/span>rimegepant<\/span> as a single 75 mg dose with <\/span>itraconazole<\/span> 200 mg daily, a well-known strong <\/span>CYP3A4<\/span> inhibitor<\/span>, increased the serum concentrations of <\/span>rimegepant<\/span> significantly. Therefore, coadministration of <\/span>Nurtec ODT<\/span> with strong <\/span>CYP3A4<\/span> inhibitors<\/span> is considered contraindicated.\u00a0<\/span><\/p>\n

Concomitant consumption could result in an increased risk of <\/span>adverse effects<\/span><\/a> of the medication, including severe headache, confusion, slurred speech, loss of coordination, stiff muscles, and high fever. If an individual takes Nurtec and a strong <\/span>CYP3A4<\/span> inhibitor<\/span> concomitantly and begins to experience any unexpected or unusual <\/span>side effects<\/span>, it is recommended to call a poison control center or get immediate medical attention.\u00a0<\/span><\/p>\n

The maximum daily <\/span>dose of Nurtec ODT<\/span> is 75mg, the only dosage form available, so this interaction cannot be counteracted by trialing alternative doses. <\/span>Zavzpret<\/span><\/a> (zavegepant) is another member of the gepant medication class that still relies on the <\/span>CYP3A4<\/span> metabolic pathway but to a lesser degree than <\/span>Nurtec ODT<\/span>; therefore, individuals on a strong <\/span>CYP3A4<\/span> inhibitor<\/span> needing a member of the <\/span>CGRP<\/span> inhibitor<\/span> drug class<\/span><\/a> may be better off with this medication, at least while the <\/span>CYP3A4<\/span> inhibitor<\/span> is warranted.\u00a0<\/span><\/p>\n

Examples of <\/span>CYP3A4<\/span> inhibitors<\/span> include:<\/span><\/p>\n