Section 02 · Monograph

Rimegepant

Reviewed Nov 2026FDA label

Nurtec ODTGepant · oral

Indications

Small-molecule calcitonin gene-related peptide (CGRP) receptor antagonist ("gepant")
Antagonizes CGRP receptors, blocking neurogenic inflammation and vasodilation implicated in migraine pathogenesis
Unique among gepants in being FDA-approved for both acute (as-needed) and preventive (every-other-day) migraine treatment

Acute treatment: 75 mg orally disintegrating tablet, taken as needed; maximum 75 mg (one dose) per 24 hours
Acute treatment: safety of treating more than 18 doses in a 30-day period has not been established
Preventive treatment: 75 mg orally every other day
May be taken with or without food; place on/under tongue to disintegrate — do not use with liquid

Renal impairment: no dosage adjustment for mild-to-severe impairment; avoid use in end-stage renal disease (CLcr <15 mL/min)

Hepatic impairment: no adjustment for mild-to-moderate (Child-Pugh A/B); avoid in severe impairment (Child-Pugh C)

History of hypersensitivity reaction to rimegepant or any component of Nurtec ODT, including reported anaphylaxis and delayed serious hypersensitivity reactions

Strong CYP3A4 inhibitors: avoid concomitant use — markedly increases rimegepant exposure
Moderate CYP3A4 inhibitors: avoid taking an additional dose of rimegepant within 48 hours
Strong or moderate CYP3A4 inducers: may substantially reduce rimegepant efficacy — avoid concomitant use
Potent P-glycoprotein (P-gp) inhibitors: avoid taking an additional dose within 48 hours
No clinically significant interaction demonstrated with common migraine co-therapies (e.g., sumatriptan) in studies conducted to date

Acute treatment: nausea (2% vs 0.4% placebo)
Preventive treatment: nausea (2.7% vs 0.8% placebo); abdominal pain/dyspepsia (2.4% vs 0.8% placebo)
Hypersensitivity reactions, including dyspnea and rash (<1%)
Postmarketing: serious hypersensitivity/anaphylaxis
Postmarketing: hypertension (new onset or worsening)
Postmarketing: Raynaud's phenomenon

Monitor for hypersensitivity reactions, which may be delayed by days after dosing
Track headache-day frequency and treatment response to confirm ongoing benefit for preventive use
Assess hepatic function status before use in impairment; avoid in severe hepatic impairment
Review concomitant CYP3A4/P-gp modulating medications at each visit
Monitor blood pressure for new-onset or worsening hypertension

Pregnancy: Available data insufficient to establish drug-associated risk; animal studies showed decreased fetal weight and skeletal variations only at doses causing maternal toxicity
A pregnancy exposure registry (Nurtec ODT/rimegepant Pregnancy Registry) monitors outcomes in women exposed during pregnancy (1-877-366-0324)
Lactation: Rimegepant is present in human breast milk; relative infant dose estimated at less than 1% of the maternal weight-adjusted dose
Consider the developmental and health benefits of breastfeeding along with the mother's clinical need for rimegepant and any potential adverse effects on the breastfed infant