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Drug vs. Drug

Nurtec vs. Aimovig: Differences, similarities & side effects

Despite belonging to the same drug class, the two migraine medications are quite different
By | Sep. 13, 2024
An injection and an oval tablet with "vs" between them: Nurtec vs. Aimovig

Key takeaways

  • Nurtec and Aimovig are both calcitonin gene-related peptide (CGRP) inhibitors that are used for episodic migraine prevention, with Nurtec having an additional use as an acute migraine reliever and Aimovig having utility in chronic migraine prophylaxis.

  • Nurtec is an orally dissolvable tablet, known also as Nurtec ODT, and Aimovig is an injectable medication.

  • The CGRP antagonists, including Nurtec and Aimovig, carry significant costs, but savings opportunities are available.

  • Drug interactions are more of a concern with Nurtec, and side effects are more problematic with Aimovig.

In this article:

Calcitonin gene-related peptide antagonists (CGRP) are seeing more and more use for migraine treatment. Nurtec (rimegepant) and Aimovig (erenumab) are two prominent members of the CGRP inhibitor drug class. While they both have proven efficacy for migraine prevention, Nurtec can also be used for acute migraine relief and comes in pill form, unlike Aimovig, which is injected. The differences between these two drug family members go even further. Understanding how they compare is important when choosing how best to control migraine headaches.

Nurtec vs. Aimovig: Key differences

CGRP receptor blockers come in two distinct varieties: the gepants and the monoclonal antibodies. Gepants, like Nurtec, Ubrelvy (ubrogepant), and Qulipta (atogepant), are oral tablets, while the CGRP monoclonal antibodies, like Aimovig, Ajovy (fremanezumab), Emgality (galcanezumab), and Vyepti (eptinezumab) are subcutaneous injections. 

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

They can all be used regularly as prophylaxis—preventive treatment to reduce the frequency, severity, or duration of migraine attacks. In fact, the American Headache Society published a position statement in April 2024 naming CGRP-targeting therapies as a first-line option for migraine prevention. Aimovig is effective in reducing headache frequency in both chronic and episodic migraine conditions, but Nurtec has only proven preventive benefits in episodic migraine.

Nurtec is unique, though, in that it can also be used for acute migraine relief. Fortunately, it comes as an orally dissolvable tablet (ODT), making it much easier to take in the setting of an acute migraine attack that often has coinciding nausea. No guidelines exist at this point for using Nurtec ODT to both prevent and relieve migraine, though, so a healthcare provider may recommend a different medication to use with Nurtec ODT. 

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

Or

What is the brand name?

 Rimegepant is the active ingredient, but there is no generic version yet. Erenumab-aooe is the active ingredient, but there is no generic version yet.
What form(s) does the drug come in? Orally disintegrating tablet Subcutaneous injection
What is the standard dosage? 75 mg orally every other day 70–140 mg injected once a month
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

 

Nurtec vs. Aimovig: Conditions treated

Both Nurtec ODT and Aimovig can be used for headache prevention in the setting of episodic migraine disorder. Prophylaxis (preventive medication) is often used when migraines are frequent (more than three per month), severe, or disabling, or when acute therapies are inadequate. Unlike Aimovig, Nurtec ODT can be used on an as-needed basis instead, for acute migraine relief.

Chronic migraine is a different condition and consists of constant headache or headaches for at least 15 days per month. Aimovig, but not Nurtec, has proven benefit in preventing headaches in chronic migraine disorder.

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

Is Aimovig better than Nurtec?

Choosing Aimovig or Nurtec based on efficacy is a complex decision. It must be made on a case-by-case basis in the context of an individual’s health history and other prescription drugs they may be taking. 

Only a healthcare provider can determine which medication is better for their patient, but there are some clinical trials to look to for information. In separate 12-week studies of episodic migraine, Nurtec cut migraine frequency at least by half in 49% of patients compared with 41% who took a placebo (an inactive substance, such as a sugar pill). Aimovig 140 mg injections did so in 46–51% of patients versus 25–32% who took a placebo. Although there are no direct head-to-head comparison studies, data from individual studies was analyzed in a published report, and Aimovig showed advantages in terms of efficacy over Nurtec, according to the authors.

Nurtec vs. Aimovig: Insurance coverage and cost comparison

Like other CGRP antagonists, Nurtec and Aimovig are both expensive. The average retail price of Nurtec is $1,326 for 8 tablets, which are taken as needed for acute relief or every other day for migraine prevention. The average retail price of Aimovig is about $1,065 for per 1 mL monthly injection. 

RELATED: How to save on Aimovig │ Nurtec copay card

Luckily, your out-of-pocket expense for Nurtec or Amivog may not come close to these prices. If you have insurance and either CGRP inhibitor is on your insurance’s drug formulary and considered a preferred option, your brand-name prescription copay may be the only expense. Without insurance, the price can still be reduced with a SingleCare discount card, which provides access to Nurtec and Aimovig coupons that can reduce your costs significantly. 

Compare Nurtec vs. Aimovig cost & coverage
Nurtec Aimovig
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 8, 75 mg tablets 1, 140 mg/mL pen
SingleCare cost* $836 $738
*Prices fluctuate and vary by pharmacy. These were some of the lowest prices charged by a major pharmacy at the time of publication.

Nurtec vs. Aimovig side effects

CGRP blockers are a well-tolerated drug class in general. They are not without their side effects, though. Nurtec side effects may include nausea and abdominal pain. Less commonly, Nurtec can lead to hypersensitivity allergic reactions involving shortness of breath and severe rash. Aimovig side effects may include cramps and injection site reactions, as well as uncommon but potentially severe constipation, allergic reactions, and hypertension (blood pressure elevation). Before starting either migraine medication, talk to your healthcare provider about which adverse effects to watch out for and how to monitor them.

Compare Nurtec vs. Aimovig side effects
Nurtec Aimovig
Side effect Applicable? Frequency Applicable? Frequency
Nausea Yes 2% No –
Abdominal pain Yes 2% No –
Injection site reactions No – Yes 5%
Constipation No – Yes 3%
Cramps, muscle spasms No – Yes 2%

Source: Nurtec drug label and Aimovig drug label.

Nurtec and Aimovig drug interactions

Interactions between CGRP inhibitors and other drugs are important to consider when starting or continuing a new medication. Looking for drug-drug interactions within your medication regimen requires the insight of healthcare providers and pharmacists, making it important to disclose all over-the-counter and prescription medications and supplements you may be taking. 

Nurtec is metabolized by the CYP3A4 enzyme, and as a result, a host of drugs can impact its drug levels and pose a hazard of increased adverse or decreased positive effects. Aimovig’s drug label does not list any direct drug-drug interaction. However, drugs that have overlapping side effects, such as any that cause constipation or impact blood pressure, could be a problem when used alongside Aimovig. The list is too extensive to be covered comprehensively here, but a partial listing helps to illustrate the issue.

Compare Nurtec vs. Aimovig drug interactions
Drug Drug class Nurtec Aimovig
Clarithromycin Macrolide antibiotic Yes No
Diflucan (fluconazole) Azole antifungal Yes No
Paxlovid (nirmatrelvir and ritonavir) COVID19 antiviral Yes No
Cardizem CD (diltiazem) Calcium channel blocker Yes Yes
St. John’s Wort Herbal antidepressant Yes No
Grapefruit juice Food Yes No
Dilantin (phenytoin) Anticonvulsant Yes No
Roxicodone (oxycodone) Opioid analgesic No Yes
Diovan (valsartan) ARB antihypertensive No Yes
Midodrine Alpha-adrenergic agonists No Yes

 

Nurtec and Aimovig Drug warnings

There are no black box warnings from the Food and Drug Administration or current recalls on Nurtec or Aimovig. That does not mean that there are no cautionary notes to consider. Regarding Nurtec, its extensive drug interactions and potential for severe allergic reactions have already been mentioned. Avoidance of Nurtec has been advised in the setting of severe kidney or liver disease. 

On the other hand, Aimovig does not have an issue with extensive drug interactions or use in the setting of kidney or liver disease. Severe allergic reactions, constipation, and blood pressure elevation are the major concerns with Aimovig. Avoiding Aimovig might be advised for those with a history of constipation or blood pressure problems.

CGRP inhibitors, including Nurtec and Aimovig, are not advised for use while pregnant due to side effect concerns and a lack of safety studies. Likewise, the use of these drugs while breastfeeding is not advised, given the lack of clinical trials demonstrating whether it is safe for the baby.

Can you take Nurtec and Aimovig together?

The utility and risk of combining two CGRP antagonists like Nurtec and Aimovig is an ongoing topic of discussion and investigation. A recent review of available data on the topic highlights potential additive benefits of the combination and brings up the inherent risks with this type of drug duo. According to the authors, the answer will depend on each individual patient’s situation.