Key takeaways

Aimovig is used to prevent migraines and operates by blocking the CGRP receptor, but it can cause side effects such as injection site reactions, constipation, and cramps.
Serious side effects include severe constipation, high blood pressure, hair loss, immunogenicity, and severe allergic reactions, with hypertension and hair loss not widely reported in clinical trials but emerging post-approval.
Aimovig’s side effects can last as long as its elimination half-life of 28 days, with most being mild and self-resolving, but severe cases may require medical intervention.
To minimize side effects, patients should inform their healthcare provider of all medical conditions and medications, follow the prescription and injection instructions carefully, and monitor for allergic reactions.

Aimovig is a brand-name prescription drug taken as a once-monthly injection to prevent episodic or chronic migraine headaches. The active ingredient in Aimovig is erenumab-aooe, a monoclonal antibody that blocks the CGRP (calcitonin gene-related peptide) receptor to prevent inflammation associated with migraines. Although effective at reducing the number of migraine days each month, Aimovig may cause certain side effects, which may be worsened by pre-existing conditions or drug interactions.

RELATED: Learn more about Aimovig

Common side effects of Aimovig

The most common side effects of Aimovig are:

Injection site reactions, including redness, pain, and inflammation
Constipation
Cramps and muscle spasms
Sores in the mouth
Rash

Serious side effects of Aimovig

The most serious side effects of Aimovig are:

Severe constipation with serious complications
High blood pressure (hypertension)
Hair loss (alopecia)
Immunogenicity
Severe allergic reactions including angioedema and anaphylaxis

Aimovig and high blood pressure

High blood pressure was not reported as a problem in clinical trials, but once the drug was approved, reports of hypertension were reported in high enough numbers for the FDA to issue a warning. Some cases of hypertension were severe enough to require hospitalization. This adverse effect is more likely to occur in people who already have high blood pressure or risk factors for high blood pressure. Problems with blood pressure can occur within seven days of an injection. The FDA recommends that people with high blood pressure or risk factors for high blood pressure monitor their blood pressure regularly while taking Aimovig.

Aimovig and hair loss

In clinical studies, hair loss was experienced by only two patients. However, since the drug has gone to market, a number of people have experienced hair loss when taking Aimovig. Some cases involve severe hair loss. The incidence is unknown (the Prescriber’s Digital Reference puts the incidence at 17%) and some healthcare professionals are uncertain if Aimovig is the primary cause. Migraine patients who experience hair loss should talk to their prescribing healthcare provider and consider alternative antibody therapies or other migraine prevention drugs, such as Topamax (topiramate) if hair loss is a problem.

Aimovig and antibody formation (immunogenicity)

Monoclonal antibodies often carry a risk for immunogenicity, in which the body develops an immune response against the monoclonal antibody. Immunogenicity is exactly how many vaccines work. A healthcare provider injects an antigen protein into a person and their body develops antibodies to those proteins. The same thing may happen with monoclonal antibody drugs. The body may develop antibodies to the drug, which may make the drug less effective over time. In clinical trials, the incidence of people developing antibodies against erenumab was 2.6 to 6.2%. However, healthcare providers are still not entirely sure if antibody formation decreases the clinical effectiveness of the drug. Resolving this question will require a few more years of use.

How long do side effects last?

Aimovig has an elimination half-life of 28 days, so it is taken as a once-a-month injection to prevent migraine attacks. Unfortunately, some side effects, such as constipation, high blood pressure, or cramps, could last just as long, though other side effects are generally mild and go away on their own as the body gets used to the drug. The most common side effect, injection site reactions, usually develop and pass within a few days.

A severe allergic reaction or severe constipation with serious complications may require medical treatment and take several days or weeks to get better. In both cases, a doctor may stop Aimovig treatment until the complications resolve.

Aimovig contraindications & warnings

Abuse and dependence

Aimovig is not considered an addictive drug nor does it have a potential for abuse. Aimovig can be discontinued without causing withdrawal symptoms or other problems.

Overdose

Because Aimovig is taken as a monthly injection, overdose is unlikely. Neither the manufacturer, Amgen, nor the FDA has reported Aimovig overdoses or possible side effects of an overdose. As with any prescription drug, if too much Aimovig is taken, seek emergency treatment or call a poison helpline.

Restrictions

Aimovig has few restrictions. The only contraindications are known hypersensitivities to erenumab, latex, rubber, or any of the inactive ingredients in the injection. The prefilled syringe contains dry natural rubber, a derivative of latex. People with allergies to latex or rubber should use the SureClick autoinjector, instead.

Aimovig can increase blood pressure, so people diagnosed with hypertension or with any of the risk factors for high blood pressure will need to have their blood pressure monitored regularly while taking Aimovig.

Neither the liver nor the kidneys are involved in breaking down or eliminating erenumab, so people with kidney disease or liver impairment can take Aimovig at normal doses.

Pregnancy and breastfeeding

There are no human studies that provide information on whether it is safe for pregnant women to take Aimovig. Animal studies have shown no evidence that Aimovig will harm a fetus. However, women who are pregnant or planning to become pregnant should get medical advice from a healthcare professional before taking Aimovig.

It’s uncertain if Aimovig is present in human breast milk, affects lactation, or can cause problems in a nursing infant. Women who are breastfeeding should talk to a healthcare provider about the pros and cons of taking Aimovig while breastfeeding.

Children

The U.S. Food and Drug Administration (FDA) has not approved the use of Aimovg in children.

Seniors

There is not enough information to determine if Aimovig is as safe and effective in migraine patients over 65 as it is in younger adults. Seniors may be started at a lower dose than usual.

Aimovig interactions

Although the FDA has not identified any drug interactions in Aimovig’s prescribing information, some drugs are used cautiously with Aimovig. You should keep a list of other prescription drugs, over-the-counter medications, and supplements you take. This list will help both the prescribing healthcare provider and pharmacist prevent possible drug interactions.

Aimovig may cause problems when combined with the following drugs:

Antidiarrheal drugs: Drugs that treat diarrhea slow down intestinal activity, allowing waste products to remain longer in the bowels. When they’re combined with Aimovig, there’s an increased risk of severe constipation and constipation-related complications. Other types of drugs also slow down intestinal motility, such as opioids and antidepressants.
Blood pressure medications: Aimovig can raise blood pressure, partly neutralizing the effects of blood pressure medications. Anyone taking blood pressure medications may need their blood pressure monitored while taking Aimovig. Dosages may need to be adjusted.
Medications that raise blood pressure: Taking Aimovig with other medications or supplements that raise blood pressure may worsen high blood pressure, particularly in people diagnosed with hypertension. Drugs that can raise blood pressure include migraine medications (both triptans and ergot drugs), stimulants (including caffeine), nonsteroidal anti-inflammatory drugs (NSAIDs such as aspirin or ibuprofen), decongestants, birth control pills, corticosteroids, and some herbal supplements.

How to avoid Aimovig side effects

Aimovig has relatively few and minimal side effects. Even so, following a few tips can both minimize side effects and maximize the benefits of Aimovig treatment.

1. Tell the prescribing healthcare provider about all medical conditions

No matter what drug is being prescribed, always make sure the prescribing healthcare provider knows about any medical conditions you have. For most drugs—and Aimovig is no exception—side effects are more likely and sometimes more severe for people with certain pre-existing conditions. In particular, conditions that the prescriber especially needs to know about when prescribing Aimovig are:

Any allergy to rubber or latex
High blood pressure
Problems with constipation or intestinal motility
Pregnancy or pregnancy plans
Breastfeeding or breastfeeding plans

2. Tell the healthcare provider about all medications being taken

Aimovig has few drug interactions. The FDA lists no significant drug interactions in Aimovig’s official drug information. Even so, it is important to tell the prescribing healthcare provider about all medications and supplements being taken. To prevent severe constipation when taking Aimovig, the healthcare provider may need to know if you take certain drugs that slow down movement in the intestines, such as antidiarrheals or opioids.

3. Take Aimovig as directed

Take Aimovig as directed by the healthcare provider. Do not take extra doses, do not skip doses, and do not stop this medication until talking to a healthcare professional.

4. Follow the instructions given in the self-injection demonstration

Using either the Aimovig prefilled autoinjector or prefilled syringe, inject a dose of Aimovig just under the skin (subcutaneous injection). It should not be injected into muscles or a vein. If Aimovig is not injected properly, the medicine won’t work as intended. A healthcare provider will provide a step-by-step demonstration for the first injection. If there are any questions or confusion during this demonstration, get these questions cleared up before leaving.

5. Read the instructions for use before each injection

Properly injecting the medicine not only ensures the maximum benefits from the medicine but also helps to prevent injection site reactions. For this reason, always read the illustrated instructions for use before any use of Aimovig. Even if you feel experienced at giving the injection, always refresh your memory by completely reading all the instructions before administering an injection.

6. Perform a safety check on each SureClick autoinjector or prefilled syringe

It’s tempting to grab the Aimovig autoinjector or syringe out of the refrigerator, give the shot, and be done with it. The safety check, however, is vitally important to ensure that the medicine works and that potentially serious problems are avoided. Always check the expiration date. Throw out the medicine if the expiration date has passed. Check the autoinjector or syringe for damage. If it’s damaged, dispose of it. Finally, check the medicine. If the medicine is cloudy or has flakes in it, don’t use it.

7. Change injection site locations

Aimovig is only injected once a month in the upper arms, thighs, or abdomen. Even though injections are infrequent, injection site reactions may be prevented by rotating the injection site each month.

8. Let Aimovig warm to room temperature before an injection

To avoid injection site reactions, don’t be hasty when giving an injection. Injecting cold medicine can cause pain and redness. Remove the Aimovig autoinjector or prefilled syringe from the refrigerator about 30 minutes before an injection. Let it stand in the carton protected from light to warm up to room temperature. Don’t heat it in any way, just let the ambient room temperature warm it up. After 30 minutes, the medicine should be ready for injection.

9. Watch for signs of an allergic reaction

Hypersensitivity reactions, though rare, are potentially serious. They can happen within hours or they could take several days to develop. Call a healthcare provider or seek emergency medical care if you notice signs of an allergic reaction, such as rash, hives, trouble breathing, or swelling of the face, throat, or mouth.

Resources

Aimovig, Epocrates
Aimovig prescribing information, U.S. National Library of Medicine

CGRP questions/answers, Robbins Headache Clinic
Erenumab-aooe drug summary, Prescriber’s Digital Reference
QuarterWatch™ (includes new data from Quarter 4, 2018 and Quarter 1, 2019) focus on four new drugs: Xofluza, Aimovig, Ajovy, and Emgality, Institute for Safe Medication Practices