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Emgality missed dose (maybe)- do loading dose again?

Hi all, new member here. I’ve been on Emgality for about 6 months with no side effects and greatly reduced migraine frequency. However, my February injection didn’t burn at all, and it usually burns like fire for a few seconds. I had the usual bruise afterwards and the pen appeared empty, but I think it may have been ineffective. My neurologist said it’s fine, and Lilly couldn’t tell me anything, but I have had an increase in migraine frequency since then. It has been a month and is time for my next dose. Should I try to do the loading dose of 2 injections again, or just carry on with one? I know no one can offer medical advice but, theoretically, what would you do? Thanks for any and all replies!

  1. Hi @txvet,

    Welcome to the discussion forum - we're glad you found us!

    I wish I could give you some direction on this, but as you mentioned we don't give medical advice. Have you reached out to the pharmacy? Maybe they have some information that would be helpful?

    And Lilly didn't give you any useful information on this? That's frustrating.

    I'm sure other will be along shortly to share their experiences with you.

    Hoping today is a good day!
    Nancy Harris Bonk, Patient Advocate/Moderator

    1. Hi txvet,
      I'm sorry the dose felt ineffective and your migraine attacks have upticked. Currently there is no advisement of times when it would be appropriate to do a loading dose again. I have been on Aimovig for 30 doses myself, and honestly, I have months where my attacks increase and months where I have very few. There can be many reasons for this. Hopefully when you do your dose this time, you will do better. Also, the half life of Emgality is 28 days. What this means is when you do your next dose, you still have 50% of the last dose in your body. So it takes about 5 months after your last injection before your body has processed all the Emgality out. Emgality is different because of the loading dose. So, it is also possible that as that loading dose decreases month by month, you may notice a difference. Emgality was approved to do the extra boost in the first month, whereas the others were not. Having been on Aimovig, I can't speak to my own experience of how that works out. For me, every dose I took of Aimovig I did better. So in theory, I would continue with the one dose, as that is what was FDA approved, and the way the half life of the medication works.

      Pain free wishes to you!
      Anna ( Team)

      1. Thank you both for the information! Lilly was of zero help, and told me to ask my doctor, who brushed me off. I will contact the pharmacy, and the information about the 28 day half life is very useful. I appreciate it!

        1. @txvet
          You're welcome! I hope your next injection goes well. Also, just a thought, make sure you follow the storage guidelines carefully. Emgality needs to stay refrigerated until you are within 7 days of being ready to use. Once it is taken out of the refrigerator, it cannot be re-refrigerated. For instance, if you pick it up at the pharmacy and you live 30 minutes away you could be getting it out of the storage guidelines to put back into the refrigerator when you get home. My Aimovig is delivered to my home so I don't have to worry about that. make sure you leave it out for at least 30 minutes before injecting. Also, so that it doesn't hurt as much, I will often take my injection out at 2pm and inject at 9pm.

          pain free wishes to you -
          Anna ( Team)

        2. I appreciate that, Anna. I'm always careful to keep it refrigerated until 30 minutes before use. I get mine at the pharmacy and it's always cold, but I just have to hope that the pharmacy has not left it out too long at some point!

      2. Good to hear, @txvet. Will you keep us posted on how you are doing?

        Have a great day! Nancy Harris Bonk, Patient Advocate/Moderator

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