Understanding the New Era of Migraine Treatment: CGRP Inhibitors
Nurtec ODT (rimegepant) and Qulipta (atogepant) are both medications in the calcitonin gene-related peptide (CGRP) receptor antagonist class. CGRP is a protein thought to play a key role in migraine. By blocking CGRP receptors, these drugs can either stop a migraine or reduce its frequency. Both are processed by liver enzymes, mainly CYP3A4.
What is Nurtec ODT (rimegepant)?
Nurtec ODT is an orally disintegrating tablet (ODT). It is approved by the FDA for two uses: treating acute migraine attacks (with or without aura) and preventing episodic migraine. Episodic migraine involves fewer than 15 headache days monthly. For acute treatment, a single tablet is used as needed, up to 18 doses per month. For prevention, one tablet is taken every other day. It is not approved for chronic migraine prevention.
Key Characteristics of Nurtec ODT:
- Active Ingredient: Rimegepant
- Form: Orally disintegrating tablet (ODT)
- Approved Uses: Acute treatment and prevention of episodic migraine.
- Dosing: As needed for acute (max 18 doses/month) or every other day for prevention.
What is Qulipta (atogepant)?
Qulipta is a standard oral tablet taken once daily specifically for migraine prevention. It is not used to treat an ongoing attack. Qulipta is FDA-approved for preventing both episodic and chronic migraine. Chronic migraine means 15 or more headache days per month. This makes Qulipta a daily option for preventing frequent or chronic migraines.
Key Characteristics of Qulipta:
- Active Ingredient: Atogepant
- Form: Oral tablet
- Approved Uses: Preventive treatment of episodic and chronic migraine.
- Dosing: Once daily.
Direct Comparison: Nurtec vs. Qulipta
Choosing between these drugs depends on individual migraine patterns, treatment goals, and tolerability. The 'better' option varies for each person.
| Feature | Nurtec ODT (rimegepant) | Qulipta (atogepant) |
|---|---|---|
| Primary Indication | Acute treatment AND prevention of episodic migraine | Prevention of episodic and chronic migraine |
| How It's Taken | Orally disintegrating tablet (dissolves on/under tongue) | Standard oral tablet (swallowed) |
| Dosing Frequency | As needed for acute attacks, or every other day for prevention | Once daily |
| Common Side Effects | Nausea, stomach pain, indigestion | Nausea, constipation, fatigue/sleepiness |
Efficacy and Side Effects
Efficacy
Both medications are effective within their approved uses. Nurtec can relieve acute pain in about an hour. For prevention, Nurtec studies showed a reduction of monthly migraine days by 0.8 to 4.3 compared to placebo. Qulipta studies showed reductions of 1.2 to 4.2 monthly migraine days versus placebo, depending on the dose. One analysis suggested Qulipta 60 mg daily was more effective than every-other-day Nurtec for prevention, reducing monthly migraine days by an average of 1.65 more days.
Side Effects and Safety
The most common side effect for Nurtec is nausea (under 3% in trials), with stomach pain and indigestion also reported. Qulipta's most common side effects are nausea, constipation, and fatigue. Qulipta's nausea incidence can range from 5% to 9% depending on dose.
Both drugs have a rare risk of severe allergic reactions (difficulty breathing, swelling) requiring immediate medical help. Post-approval reports also mention new or worse high blood pressure and Raynaud's phenomenon with both.
Conclusion: Which One is "Better"?
Deciding between Nurtec and Qulipta depends on individual needs. There's no single 'better' option.
- Nurtec offers flexibility: It suits those with episodic migraines needing one medication for both acute treatment and some prevention. Its ODT form helps those with nausea during attacks.
- Qulipta offers dedicated prevention: It's for those needing consistent daily prevention, especially with chronic migraines (15+ headache days per month). Since Nurtec isn't for chronic migraine prevention, Qulipta is the better choice in this case.
The decision should always be made with a healthcare provider who can evaluate migraine patterns, history, and goals to choose the most suitable medication.
For more information from an authoritative source, you can visit the American Migraine Foundation.
