Section 02 · Monograph
Erenumab
Reviewed Nov 2026FDA label
AimovigCGRP mAb · injectable
- Forms
- SC autoinjector: 70, 140mg
- Dose
- 70-140mg SC monthly
- MOA
- Blocks CGRP receptor
Indications
- Preventive treatment of migraine in adultsFDA-labeled
Mechanism of Action
- Fully human IgG2 monoclonal antibody
- Binds directly to the CGRP RECEPTOR (not the CGRP ligand) and antagonizes CGRP receptor function, blocking CGRP-mediated signaling
- Mechanistically distinct from ligand-binding anti-CGRP antibodies (e.g., fremanezumab, galcanezumab, eptinezumab), which bind the circulating CGRP peptide rather than its receptor
Full Dosing
Adult / usual
- 70 mg subcutaneously once monthly
- Some patients may benefit from 140 mg once monthly, administered as two consecutive 70 mg injections
- Administer via prefilled autoinjector or prefilled syringe into the abdomen, thigh, or upper arm; allow to reach room temperature before injection
Renal
- No dose adjustment established or required for renal or hepatic impairment
Contraindications
- Serious hypersensitivity to erenumab-aooe or any excipient (reactions have included anaphylaxis and angioedema)
Drug Interactions
- No clinically significant pharmacokinetic drug-drug interactions identified; not metabolized by cytochrome P450 enzymes
- No significant interaction observed with oral contraceptives or sumatriptan in studies
- Use with caution alongside other medications that reduce GI motility given postmarketing reports of severe constipation
Adverse Effects
- Injection site reactions (~5-6%)
- Constipation (~1-3%)
- Muscle spasm
- Hypersensitivity reactions including rash, angioedema, and anaphylaxis (postmarketing)
- Severe constipation with serious complications requiring hospitalization or surgery, often after the first dose (postmarketing)
- New-onset or worsening hypertension, sometimes requiring hospitalization (postmarketing)
- Raynaud's phenomenon (postmarketing)
Monitoring Parameters
- Signs/symptoms of hypersensitivity reaction (may occur from hours to more than a week after dosing)
- Bowel function/severe constipation, particularly in patients with risk factors for GI complications
- Blood pressure for new-onset or worsening hypertension
- Signs/symptoms of Raynaud's phenomenon; discontinue if it develops
Pregnancy & Lactation
- Pregnancy: no adequate human data; animal studies at exposures ~20x clinical dose showed no adverse fetal effects; as an IgG antibody, placental transfer increases with gestational age, greatest in the third trimester
- Pregnancy exposure registry available to monitor outcomes
- Lactation: no data on presence in human milk, effects on the breastfed infant, or effects on milk production; consider developmental/health benefits of breastfeeding along with the mother's clinical need for AIMOVIG