CGRP Gepants

Reviewed by: HU Medical Review Board | Last reviewed: May 2023

CGRP (calcitonin gene-related peptide) gepants are a newer option for acute/abortive treatment or prevention of moderate-to-severe migraine. These drugs may be offered to people who cannot take triptans or do not respond to triptans or other migraine therapies.1,2

How do CGRP gepants work?

CGRP is a protein found in our bodies. It is responsible for carrying pain signals along nerves. These nerves have a role in causing head pain linked to migraine. Gepants work by blocking CGRP from attaching to its receptor. This prevents CGRP from initiating a pain signal.3

Unlike triptans, CGRP gepants do not constrict blood vessels. This means CGRP gepants may be an option for people with a history of heart disease, strokes, or blood vessel disease. Triptans may not be safe for this group of people.3

Examples

As of early 2023, four CGRP gepants have been approved buy the FDA to treat migraine:4-7

Ubrelvy and Zavzpret are approved only for the acute treatment of migraine. This means they are meant to be taken at the first sign of a migraine to reduce severity and ease symptoms. Qulipta is approved only for preventive treatment, meaning it is meant to be taken every day to decrease the number of migraine attacks. Nurtec is approved for both acute treatment and prevention of migraine.4-7

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. In general, the most common side effects of CGRP gepants include:4-7

  • Nausea
  • Constipation
  • Tiredness
  • An allergic reaction (such as rash, shortness of breath, or swelling of the tongue, mouth, or throat)
  • Dry mouth

Medication overuse headaches are unlikely to be a problem with gepants.8

These are not all the possible side effects of CGRP gepants. Talk to your doctor about what to expect when taking these drugs. Call your doctor if you have any changes that concern you when taking these drugs.

Other things to know

Large, high-quality studies of people treated with gepants showed that:9,10

  • 20 percent are pain-free at 2 hours
  • 60 percent have pain relief at 2 hours
  • 35 percent are free of their most bothersome migraine symptoms at 2 hours
  • 36 percent to 48 percent have sustained pain relief 24 hours after treatment

Studies of people treated with Qulipta or Nurtec showed that they had significantly fewer days with migraine per month.2,10

CGRP gepants may not be safe for all people. If you are interested in taking one of these drugs, tell your doctor if you have kidney or liver problems.2-4

CGRP gepants may also not be safe if you are pregnant or breastfeeding. Talk to your doctor about your options for birth control and breastfeeding while taking these drugs.4-7

Before beginning treatment for migraine, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

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