Concomitant Use of Rimegepant and Sumatriptan for Migraine  Appears Safe and Tolerable

In a phase 1 clinical trial, concomitant use of rimegepant (Nurtec; Biohaven Pharmaceuticals, New Haven, CT) with subcutaneous sumatriptan was safe and well tolerated. The pharmacokinetics of both treatments were not affected when administered to individuals with migraine. These results were published in Cephalgia Reports.

This is the first study to address comcomitant use of rimegepant and any triptan, a key first step in answering the migraine community’s questions of whether gepants can be taken in conjunction with triptans. These positive initial findings are consistent with the favorable safety profile of rimegepant for acute treatment of migraine, for which it is indicated. The ability to combine rimegepant with triptans may be especially important if rimegepant becomes indicated for preventive migraine treatment, which is under review by the Food and Drug Administration (FDA) at present.  

On day 1, participants received 12 mg of sumatriptan as 2 subcutaneous 6 mg injections separated by 1 hour. From days 2 to 4, participants received rimegepant or placebo once daily (randomized 6 to 1, rimegepant to placebo). On day 5, participants received rimegepant or placebo, followed 2 hours later by 2 subcutaneous 6 mg injections of sumatriptan, separated by 1 hour. Sumatriptan was administered at the same times as on day 1.

All participants treated were analyzed throughout the duration of the study. There were no significant differences in the time-weighted average of mean arterial pressure, diastolic blood pressure, or systolic blood pressure between treatment with rimegepant and sumatriptan and sumatriptan alone. Coadministration of rimegepant and sumatriptan had no effect on the pharmacokinetics. Adverse events were experienced by 93% (39/42) of participants, with injection site reactions most frequent (60% [29/42]).

Participants (n=42) were healthy nonsmoking men (age 18- 40) and women (age 18-50) years. The study randomized, partially blinded, and placebo-controlled to observe haemodynamic effects, pharmacokinetic interactions, and safety.