Can you take Tylenol or ibuprofen with Nurtec?

In this article:

• Nurtec with Tylenol or ibuprofen
• What to avoid on Nurtec
• Alternatives
• The bottom line

In this article

• Nurtec with Tylenol or ibuprofen
• What to avoid on Nurtec
• Alternatives
• The bottom line

At least 39 million Americans live with migraine headaches. At best, they’re annoying, and at worst, they’re debilitating. Fortunately, there are many different medications available for the treatment and prevention of migraine, like Nurtec orally disintegrating tablets (ODT). “Nurtec can be used not only at the onset of a migraine attack to relieve pain but also to prevent future migraine occurrences when taken every other day continuously,” says neurologist Lauren R. Natbony, MD, the Medical Director of Integrative Headache Medicine of New York and an Assistant Clinical Professor of Neurology at the Icahn School of Medicine at Mount Sinai. “This versatility makes it an excellent option for patients requiring acute and preventive treatment in one.“

But what happens if you hurt your back or stub your toe while taking Nurtec (rimegepant)? Or if you have a breakthrough migraine that’s just unbearable? It’s perfectly safe to take another pain reliever like Tylenol (acetaminophen) or ibuprofen while on Nurtec. Here’s everything you need to know.

Combining Nurtec with over-the-counter pain relievers

“You can take as-needed OTC pain relievers, like acetaminophen or ibuprofen, while

taking Nurtec ODT,” affirms Luke Hentrich, Pharm.D., an Assistant Professor in the Department of Clinical Pharmacy and Translational Science at The University of Tennessee Health Science Center College of Pharmacy. Nurtec belongs to a drug class called calcitonin gene-related peptide (CGRP) receptor antagonists, also known as gepants. While it’s important to talk to your healthcare provider or pharmacist before combining medications, there are no known drug interactions between gepants and over-the-counter pain relievers. According to the patient information for Nurtec, the only reason listed for which people should not take the medication is if they have known allergic reactions to rimegepant or one of the other ingredients.

“If you do need to take another pain reliever with Nurtec, the safest OTC pain relievers are acetaminophen, ibuprofen, or naproxen,” Dr. Natbony says. Naproxen is sold under the brand name Aleve, while ibuprofen is the active ingredient in Advil and Motrin. However, it’s important not to overdo it with OTC pain relievers.

However, there is one caveat: rebound headaches when the medication wears off. “Taking OTC pain relievers more than 15 days per month may lead to what is known as medication overuse headache,” notes Dr. Hentrich. If you are already dealing with migraine headaches, that’s the last thing you want.

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Precautions and contraindications while on Nurtec

Nurtec is broken down in the liver by the CYP3A4 enzyme. For this reason, any medications, supplements, or foods that interfere with this enzyme should be avoided while you’re taking Nurtec. Drugs that inhibit the action of this enzyme may increase levels of Nurtec in your body and increase side effects. Drugs that induce the action of this enzyme reduce levels of Nurtec and make it less effective. Some examples include:

• Over-the-counter supplements, such as St. John’s wort
• Antibiotics, including clarithromycin and erythromycin
• Antiseizure drugs, such as carbamazepine, phenytoin, and cenobamate

However, this is not a complete list. There are a variety of medications that interact with Nurtec. You should always seek medical advice from a healthcare professional about any medications you’re taking before you start taking Nurtec to make sure none interfere with its effects.

You should not take Nurtec ODT “with grapefruit juice, as it may increase Nurtec ODT levels and increase the incidence of side effects,” explains Dr. Hentrich. The most common side effects of Nurtec, whether you’re taking it for acute treatment of migraine or preventively, are nausea, stomach pain, or indigestion.

“If you’re prone to nausea, taking Nurtec with a small snack or light meal can help alleviate discomfort,” says Dr. Natbony. “To prevent side effects, stick to the prescribed dosage and do not take more than one dose in 24 hours or exceed 18 doses in 30 days.” If you do experience intolerable side effects, stop taking the Nurtec so you can find a different treatment—there are many others that may be better for you.

Can you mix pain relievers with other migraine medications?

“Most migraine medications can be safely combined with over-the-counter pain relievers when necessary,” says Dr. Natbony. “Triptans and gepants, for instance, are typically taken alongside NSAIDs [nonsteroidal anti-inflammatory drugs] like ibuprofen and naproxen or acetaminophen for added pain relief.”

However, you should not take over-the-counter NSAIDs if you are taking a prescription NSAID for migraines, such as Cambia (diclofenac potassium) or Elyxyb (celecoxib). The active ingredients work the same way to reduce pain as ibuprofen does, so taking them at the same time could increase your risk of stomach irritation, gastrointestinal bleeding, kidney strain, or liver problems, says Dr. Natbony.

It’s also important to note that some OTC pain relievers are combination products, meaning they contain additional ingredients that could increase your risk of side effects. “Some OTC acetaminophen products that contain caffeine, as well as NSAIDs, may increase your blood pressure if they are taken frequently over long periods, which is a monitoring consideration with triptans,” says Dr. Hentrich.

The bottom line

If you need to take an OTC pain reliever like Tylenol or ibuprofen while taking Nurtec to treat migraine headaches, it’s perfectly safe to do so—they won’t interfere with Nurtec’s ability to treat your migraine pain. Just be sure not to overdo it, as that can cause rebound headaches that leave you in a cycle of pain and discomfort. Even though you likely have a host of OTC pain relievers in your medicine cabinet, be sure to speak to your healthcare provider before changing your migraine treatment regimen or supplementing with other medications. Doing so will ensure that you’re effectively treating migraine symptoms without unpleasant side effects.