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Nurtec side effects and how to avoid them

Nurtec side effects include allergic reactions
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By | Dec. 15, 2022 Medically reviewed by Josephine Bawab, Pharm.D.
Rx pills and prescription pad: Nurtec side effects

Key takeaways

  • Nurtec, used for treating or preventing migraines, primarily has nausea and abdominal pain as its common side effects, with serious reactions being rare and usually involving hypersensitivity like skin rash and breathing troubles.

  • No serious long-term side effects have been identified for Nurtec, making it suitable for prolonged use in migraine prophylaxis without significant long-term health risks.

  • Nurtec has multiple drug interactions, especially with those affecting its metabolism through the liver enzyme CYP3A4, necessitating caution and consultation with healthcare providers regarding current medications.

  • To minimize side effects, it’s recommended to inform healthcare providers about all medical conditions and medications, adhere to prescribed dosages, potentially take with food to ease stomach issues, and avoid grapefruit products.

In this article:

 

Nurtec is a brand-name prescription drug used to treat or prevent migraine headaches. Migraine is a disorder of the nervous system and blood vessels. It is provoked by nerves in the head, but the worst symptoms, including migraine pain, are caused by the rapid dilation of blood vessels in the head. The active ingredient in Nurtec, rimegepant, prevents or reverses this rapid dilation of blood vessels by blocking the molecule that causes it. This molecule is a small protein-like substance (peptide) called calcitonin gene-related peptide (CGRP). Migraines can be relieved or prevented by drugs that block this peptide. Some of these drugs are monoclonal antibodies. Others, like Nurtec, are called CGRP receptor antagonists. 

Unlike monoclonal antibodies, which are taken as injections, Nurtec is taken as an orally disintegrating tablet (ODT) or a sublingual tablet. It is also taken more frequently than antibody injections, either during a migraine attack or once every other day for the preventive treatment of episodic migraine. Side effects are limited and not very commonly experienced. Most people can take this drug and feel fine. The only significant worry is potential drug reactions.

RELATED: What is a silent migraine?

Common side effects of Nurtec

In clinical trials, the most common side effect of Nurtec ODT was nausea (in about 2% to 3% of participants) and abdominal pain or indigestion (in about 2% of participants). That’s the complete list of common side effects.

Serious side effects of Nurtec

In clinical trials, no serious side effects were reported. The most serious side effects of Nurtec are hypersensitivity reactions, including skin rash (less than 1% of patients), and trouble breathing (less than 1%).

Nurtec and allergic reactions

Allergic reactions caused by Nurtec have been mild reactions: skin rash and trouble breathing. These reactions were reported by less than 1% of clinical trial participants. Although these are mild side effects, an allergic reaction has the potential to be serious. Nurtec ODT should be stopped if a skin rash, shortness of breath, or wheezing is experienced. Report the reaction immediately to the prescriber.

How soon do Nurtec side effects start?

Nausea, upset stomach, and stomach pain usually happen early in treatment. An allergic reaction could rapidly happen right after the first dose. However, in clinical trials, some people didn’t experience allergic reactions until days after treatment had started. Allergic reactions happening even later in treatment have also been reported.

How long do Nurtec side effects last?

The duration of Nurtec side effects depends on how it’s being used. If it’s being taken to manage migraine attacks, the side effects typically wear off in a day or two. If Nurtec is being taken every other day, then nausea and stomach troubles should improve over time as the body adapts to the drug or as measures are taken to mitigate the effects. However, allergic reactions will require that the drug be discontinued.

What are the long-term side effects of Nurtec?

As a migraine prophylactic, Nurtec is intended for long-term use for months, if not years. There are no side effects specifically due to prolonged use of rimegepant. Nurtec does not have any serious side effects that may have long-term consequences.

Nurtec contraindications

Nurtec is never given to anyone who has had an allergic reaction to rimegepant. Because rimegepant is broken down by the liver, Nurtec is contraindicated in anyone with severe liver disease.

Pregnancy

Nurtec can be prescribed to pregnant women, but with caution. There is no information about rimegepant’s safety in pregnant women, but animal studies suggest that there is little risk to the unborn baby. However, untreated migraines increase the risk for pre-eclampsia and gestational hypertension, so the benefits of rimegepant may outweigh the risks for some. 

Breastfeeding

Nurtec can be prescribed to women who are breastfeeding. The drug is present in human breast milk, but in very small amounts. The effects on the nursing infant are unknown, but the risk is considered low. 

Children

The FDA has not approved Nurtec for use in anyone younger than 18 years of age. Keep this medication out of the reach of children.

Seniors

Nurtec is considered to be as effective and safe in people older than 65 years of age as it is in younger adults.

Nurtec warnings

As a drug that doesn’t cause very many side effects or other issues, Nurtec doesn’t have many warnings or cautions. 

Cautions

Rimegepant does not worsen any pre-existing medical conditions of which we know. While it is broken down by the liver, no dosage adjustments are required in people with mild to moderate liver dysfunction. However, it should never be used in people with severe liver disease. It is also avoided in anyone with end-stage kidney disease or on dialysis.

The only warnings attached to Nurtec are allergy warnings. Although severe allergic or drug reactions to Nurtec have not been experienced in studies, the drug should be discontinued if a skin rash or similar reaction develops.

Abuse and dependence

Nurtec is not associated with abuse or addiction. Rimegepant, its active ingredient, does not cause physical dependence or withdrawal symptoms. 

Overdose

Call a poison control center or get immediate medical attention if too much Nurtec is taken. The maximum dose for any 24-hour period is 75 mg. 

Nurtec interactions

Even though Nurtec has mild and uncommon side effects, it has several major drug interactions. This is because some other drugs can slow down or speed up the metabolism of rimegepant. Drugs that slow down the body’s breakdown of rimegepant can increase its levels in the blood. Drugs that speed up the body’s breakdown of rimegepant can decrease its ability to treat or prevent migraines. 

Drugs that slow down the body’s metabolism of rimegepant do so by blocking the liver enzyme, CYP3A4, so they’re called CYP3A4 inhibitors. Significant CYP3A4 inhibitors include:

Drugs that decrease rimegepant in the body and reduce its effectiveness are CYP3A4 inducers. Significant CYP3A4 inducers include:

How to avoid Nurtec side effects

Most people will not have side effects when taking Nurtec. The risk of side effects can be decreased even more by following a few suggestions.

1. Tell the prescribing healthcare provider about all medical conditions

The first step in avoiding side effects is to tell the prescriber about all past and present medical conditions, especially:

  • Liver problems
  • Kidney problems
  • Pregnancy or plans to get pregnant
  • Breastfeeding or plans to breastfeed

2. Tell the prescriber about all drugs being taken

The second way to avoid side effects is to tell the prescriber about all drugs being taken. Nurtec has many drug interactions, so tell the prescriber not only about all prescription drugs, but also over-the-counter medications and supplements, too. If a new drug is started, tell the prescriber.

3. Take only one dose of Nurtec ODT each day

Take Nurtec ODT as prescribed. The prescriber may also give you a schedule. For the acute treatment of migraine symptoms, take a dose when needed, but do not take more than one orally dissolving tablet in a single 24-hour period.

4. Don’t take more than 18 doses in a month

It’s not known if Nurtec is safe to take more than 18 times in a 30-day period. To be safe, take Nurtec no more than 18 times every 30 days. If taking Nurtec for migraine prevention, a total of 15 doses will be taken each month.

5. Read the patient information sheet

Nurtec ODT comes with a patient information sheet that contains useful information about side effects, possible problems, and what to do in case something goes wrong. Read this patient information sheet before taking Nurtec. If there are any questions, ask the prescriber or pharmacist for clarification.

6. Follow the instructions on the patient information sheet

The patient information sheet also includes detailed instructions on how to remove Nurtec tablets from the blister pack and how to take them. This is very important. It may not help prevent side effects, but it will help maximize the benefits of taking this drug.

7. Try taking the dose with food

To prevent nausea and stomach upset, take each dose of Nurtec ODT with a meal or a snack.

8. Avoid grapefruit

Grapefruit or grapefruit juice could increase the likelihood of Nurtec side effects.

8. Talk to the prescriber about other migraine medications

Nurtec can be taken with other migraine medications. Some people may use Nurtec to treat migraine symptoms during an attack and use another drug for migraine prevention. Before combining Nurtec with other migraine medications—especially nonprescription drugs—ask the prescriber for medical advice.

How to treat side effects of Nurtec

Most people will need to do nothing about the side effects of Nurtec ODT because they won’t have any. Here’s what to do in the rare exceptions:

Nausea

Try to drink fluids in small amounts. Ask the prescribing healthcare professional if it’s okay to take antihistamines or other anti-nausea drugs. If nausea persists or grows worse, talk to the prescriber.

Indigestion or stomach pain

Try taking the Nurtec ODT with food. Ask the prescriber if it’s okay to use antacids to calm any indigestion or stomach pain. If pain is severe or persistent, talk to the prescriber.

Allergic reactions

Stop taking Nurtec and get medical attention at any sign of an allergic reaction, including skin rash, trouble breathing, or swelling of the face, mouth, or throat.

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