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Drug vs. Drug

Emgality vs. Nurtec: Differences, similarities & side effects

These migraine medications are very different despite belonging to the same drug class
By | Sep. 13, 2024
A syringe and a pill with "vs" between them: Emgality vs. Nurtec

Key takeaways

  • Emgality is a monoclonal antibody injected monthly, and Nurtec is an oral tablet taken as often as every other day to prevent migraine.

  • The benefits of Emgality extend from episodic and chronic migraine prevention to acute cluster headache relief, while Nurtec can be effective for both episodic migraine prevention and acute relief.

  • Price can be a significant concern with both Egality and Nurtec, but insurance often covers the medications, and there are ways to save without insurance.

  • Side effects are not a frequent occurrence with either drug, but severe allergic reactions are possible with either.

  • Unlike Emgality, Nurtec interacts with a number of other drugs as a result of how it is metabolized.

In this article:

While Emgality (galcanezumab) and Nurtec (rimegepant) are both medications that are prescribed for migraine treatment, they are very different medicines with different methods of administration, side effects, costs, and more. It’s worth comparing the two medications when discussing migraine treatment with your healthcare provider, considering CGRPs were just named a first-line option for migraine prevention by the American Headache Society. 

Emgality vs. Nurtec: Key differences

As calcitonin gene-related peptide (CGRP) inhibitors, Emgality and Nurtec provide similar results, but they’re achieved by different means. Emgality is a monoclonal antibody that blocks the CGRP receptor, and Nurtec is a small molecule called a gepant that blocks the same receptor. Aside from how they work, they’re also administered differently. Emgality is injected monthly under the skin, while Nurtec is taken as an orally disintegrating tablet (ODT) that dissolves in your mouth.

Alternative gepants, all taken orally like Nurtec, include Ubrelvy (ubrogepant), and Qulipta (atogepant). Other CGRP monoclonal antibodies, like Emgality, consist of Ajovy (fremanezumab), Aimovig (erenumab), and Vyepti (eptinezumab), all of which require subcutaneous injections.

RELATED: Nurtec vs. Aimovig: Differences, similarities & side effects

Capabilities are another way that these meds distinguish themselves from one another. Emgality carries Food and Drug Administration (FDA) approval for the prevention of episodic and chronic migraine, as well as the acute treatment of cluster headaches. In comparison, Nurtec ODT prevents episodic migraines but is not indicated for chronic migraines. Nurtec’s usage extends to the acute relief of episodic migraine, unlike Emgality, but not cluster headaches.

Compare Emgality vs. Nurtec key differences
Emgality Nurtec
Drug class Monoclonal antibody CGRP inhibitor Gepant CGRP inhibitor
Brand/generic status Brand Brand
What is the generic name?

Or

What is the brand name?

 Galcanezumab-gnlm is the active ingredient. It is not available in generic form. Rimegepant is the active ingredient. It is not available in generic form.
What form(s) does the drug come in? Subcutaneous injection Orally disintegrating tablet
What is the standard dosage? 120 mg injected once a month 75 mg orally every other day
How long is the typical treatment? Undefined but about 6–12 months if well controlled Undefined but about 6–12 months if well controlled
Who typically uses the medication? Adults Adults

 

Emgality vs. Nurtec: Conditions treated

Migraine can be episodic or chronic. Episodic migraines occur at varying frequencies, and when they become often enough (usually more than three times per month) or severe enough, healthcare providers may recommend prophylactic (preventive) medicine. Chronic migraine may continue constantly or occur at least 15 times per month. The best treatment depends on the type of migraine it is. 

You can take either Emgality or Nurtec to prevent episodic migraines: Nurtec ODT as a 75mg tablet every other day or Emgality 120 mg injected once a month. Nurtec is also an option for acute migraine relief. But if you’re taking Nurtec for prevention, your healthcare provider may recommend a different medication for acute migraine relief, considering the lack of studies on dual use.

Emgality can also prevent chronic migraines, which is a distinct difference from Nurtec. Another unique characteristic of Emgality is that a higher-dose injection of the drug can be used for acute relief of a cluster headache.

Compare Emgality vs. Nurtec conditions treated
Condition Emgality Nurtec
Episodic migraine, prophylaxis Yes Yes
Acute migraine relief No Yes
Chronic migraine, prophylaxis Yes No
Acute cluster headache relief Yes No

 

Is Nurtec better than Emgality?

Whether Nurtec or Emgality is a better choice is a loaded question that requires expert help. Your healthcare provider will need to consider each drug’s advantages and disadvantages in the context of your other health conditions, other medicines, and headache details.

With that said, there are findings from clinical studies that could assist in their decision-making. In a randomized study published in 2018, Emgality cut the number of migraine days per month down by 4.7 days compared to 2.8 days with a placebo (sugar pill) after six months of treatment. In a 12-week study involving Nurtec, the drug reduced migraine days per month by 4.3 days versus 3.5 days with a placebo. And, a recent head-to-head study comparing the two CGRP inhibitors found Emgality and Nurtec to have similar efficacy for the prevention of episodic migraine.

Emgality vs. Nurtec: Insurance coverage and cost comparison

CGRP antagonists are pricey, and Emgality and Nurtec are no exceptions. Emgality costs an average of $934 for one 1 mL pen, which is a monthly dose. The average retail price of Nurtec is $1,326 for 8 tablets, an amount that lasts a variable amount of time when used on an as-needed basis for acute migraine relief. 

If you have insurance, your out-of-pocket expense or copay could be much less depending on whether Emgality or Nurtec are included in your plan’s formulary and categorized as a preferred agent. Without insurance, the amount you spend on Nurtec or Emgality could be dramatically reduced by using a SingleCare discount card. With the card, you can access digital coupons for Nurtec and Emgality that can significantly lower your costs.

Compare Emgality vs. Nurtec cost & coverage
Emgality Nurtec
Typically covered by insurance? Yes but coverage varies Yes but coverage varies
Typically covered by Medicare Part D? Yes but coverage varies Yes but coverage varies
Quantity 1, 120 mg/mL pen 8, 75 mg tablets
SingleCare cost* $693 $836
*Prices fluctuate and vary by pharmacy. These were some of the lowest prices charged by a major pharmacy at the time of publication.

Emgality vs. Nurtec side effects

Both CGRP inhibitors are typically well tolerated. Nonetheless, their side-effect profiles contain some differences that are worth pointing out. Nurtec side effects include nausea and abdominal pain, as well as rare hypersensitivity allergic reactions involving shortness of breath and severe rash. Emgality’s side effects may also include severe allergic reactions, but it is more commonly tied to injection site reactions.

Compare Emgality vs. Nurtec side effects
Emgality Nurtec
Side effect Applicable? Frequency Applicable? Frequency
Nausea No Yes 2%
Abdominal pain No Yes 2%
Injection site reaction Yes 18% No
Source: Emgality drug label and Nurtec drug label

Emgality and Nurtec drug interactions

While Emgality does not have any listed interactions with other drugs, Nurtec has many. Nurtec’s metabolism by the CYP3A4 enzyme sets it up to be affected by any food or drug that negatively or positively affects that enzyme. As a result, adverse event risk can be heightened, or efficacy could be diminished. 

The list of drug interactions is expansive, but a few will be highlighted here to call attention to the common agents and drug classes involved. Be sure to have your healthcare provider and pharmacist look over your list of prescription drugs, over-the-counter medications, and supplements before starting any medication. 

Compare Emgality vs. Nurtec drug interactions
Drug Drug class Emgality Nurtec
Clarithromycin Macrolide antibiotic No Yes
Diflucan (fluconazole) Azole antifungal No Yes
Paxlovid (nirmatrelvir and ritonavir) COVID19 antiviral No Yes
Cardizem CD (diltiazem) Calcium channel blocker No Yes
St. John’s Wort Herbal antidepressant No Yes
Grapefruit juice Food No Yes
Dilantin (phenytoin) Anticonvulsant No Yes

 

Emgality and Nurtec drug warnings

The FDA has not applied any black box warnings to either Emgality or Nurtec’s label. No current recalls exist for the products either. Rare but severe allergic reactions are really the biggest item to be forewarned about, meaning that one should seek medical attention for any rash, swelling, or difficulty breathing. 

Concurrent health conditions can change decision-making about the CGRP receptor blockers. Unlike Emgality, Nurtec is generally avoided in severe kidney or liver disease due to potential risks if the medication’s elimination is impaired. Neither drug is recommended during pregnancy or while breastfeeding based on the lack of studies demonstrating safety in these situations.

Can you take Emgality and Nurtec together?

The answer will depend on an individual’s specific health and headache history, according to the authors of a review on the subject of using two CGRP inhibitors together. A specific question would be whether Emgality could be used for episodic migraine prevention while Nurtec is taken for any acute, breakthrough migraine. Get the medical advice of your healthcare provider if this option interests you. You should understand what additional benefits and risks this might entail.