Ubrelvy alternatives: What can I take instead of Ubrelvy?

In this article:

• What can I take in place of Ubrelvy?
• Compare Ubrelvy alternatives
• Top 5 Ubrelvy alternatives
• Natural alternatives to Ubrelvy
• How to switch to a Ubrelvy alternative

In this article

• What can I take in place of Ubrelvy?
• Compare Ubrelvy alternatives
• Top 5 Ubrelvy alternatives
• Natural alternatives to Ubrelvy
• How to switch to a Ubrelvy alternative

Headaches. We’ve all had them and know they can be a nuisance to daily life. There are several types of headaches, including tension, sinus, and cluster headaches. Causes for these types of headaches can range from hunger, an infection, physical exertion, or stress. Migraines can be debilitating and impact quality of life significantly, so means to manage this condition are critical in minimizing suffering. Medications are one component of available management strategies to relieve migraine symptoms. Some medications are available as a preventive treatment, while other treatment options are available to stop an acute migraine attack from progressing beyond the first sign of an oncoming migraine—otherwise known as an aura.  

Ubrelvy (ubrogepant) is a medication available for acute management of a migraine. It is a member of the drug class known as calcitonin gene-related peptide (CGRP) antagonists, sometimes called “gepants.” This class of medications is beneficial in that they are not associated with a phenomenon known as medication overuse headache. This type of headache, stemming from any primary headache, such as migraines, is secondary and induced by drugs. Ubrelvy is approved by the U.S. Food and Drug Administration (FDA) for the acute treatment of moderate to severe migraines. Individuals may seek alternatives to Ubrelvy based on cost, efficacy, side effects, allergic reactions, comorbid conditions like severe kidney impairment, and drug interactions. Fortunately, several options are available for managing acute migraine. However, finding the right treatment might take some testing to see what works best for each person.

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What can I take in place of Ubrelvy?

There are different choices for treating sudden migraine headaches if Ubrelvy doesn’t work. These alternative migraine medications block CGRP or other classes of medications such as triptans, analgesics like non-steroidal anti-inflammatory drugs (NSAIDs), selective serotonin 5-HT1F agonists, and others. Alternatives to Ubrelvy may be more suitable for certain individuals due to comorbid conditions or their different side effect profiles, routes of administration, and cost. 

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Top 5 Ubrelvy alternatives

The following are some of the most common alternatives to Ubrelvy for the acute treatment of migraines.

1. Cambia (diclofenac)

Cambia (diclofenac) is an oral solution approved by the FDA for treating migraines. It is a type of non-steroidal anti-inflammatory drug (NSAID). The onset of action is less than 2 hours, but it has a short half-life of 2 hours—so it will not provide long-standing benefits. It is administered as a single 50 mg dose. NSAIDs have been around for many years, many of which are available over-the-counter (OTC), so there is a good understanding of short- and potential long-term side effects, which patients they are safe for, and which patients should avoid them. For example, NSAID prescribing information contains a boxed warning for an increased risk of serious, potentially fatal, adverse cardiovascular thrombotic events, including myocardial infarction (MI) and stroke. They also carry a boxed warning due to a heightened risk of severe gastrointestinal (GI) inflammation, ulceration, bleeding, and perforation, which could be fatal. Therefore, individuals with a history of peptic ulcer disease or GI bleeding, or those at a heightened risk for significant GI complications, should steer clear of them.

2. RizaFilm (rizatriptan)

RizaFilm (rizatriptan) is in the triptan drug class and is an FDA-approved formulation of the compound rizatriptan. Rizatriptan has been commercially available as a tablet (Maxalt) and orally disintegrating tablet (Maxalt ODT). Generally, individuals do not receive CGRP antagonists like Ubrelvy until they have failed two triptans or cannot use triptans due to contraindications like a history of coronary artery disease, stroke, peripheral vascular disease, clinically uncontrolled high blood pressure, or received other triptans or ergot derivatives within 24 hours. For individuals with severe nausea and vomiting, migraines that intensify quickly, or those who experience migraines upon awakening, RizaFilm is a good alternative option. It’s suitable for patients aged 12 and older, weighing at least 40 kilograms, and those who cannot swallow tablets. RizaFilm is placed on the tongue, where it disintegrates within approximately two minutes, with a time to peak in the bloodstream in just over an hour. Additionally, RizaFilm is associated with fewer drug interactions compared to Ubrelvy and should only be avoided when taken with monoamine oxidase inhibitors (MAOIs). 

3. Zavzpret (zavegepant nasal spray)

Zavzpret is in the same medication class as Ubrelvy, CGRP inhibitors, and is indicated for acute treatment of moderate to severe migraines. Calcitonin gene-related peptide (CGRP) is a potent vasodilator produced by neurons in the central and peripheral nervous systems, which is presumed to be related to the pain associated with a migraine attack. In the central nervous system, raised levels of CGRP are elevated both during a migraine attack and between attacks. Zavzpret’s mechanism of action is to work as a CGRP inhibitor, preventing the interaction between CGRP and its receptor. While Ubrelvy requires dose adjustments for patients with moderate renal and hepatic impairment, Zavzspret does not. Still, it should be avoided in individuals with severe forms of kidney and liver disease. Zavzpret, despite belonging to the same drug class as Ubrelvy, presents fewer drug interactions compared to Ubrelvy, particularly with potent CYP3A4 inhibitors. Zavzpret is also available as a nasal spray. This formulation has a short onset of action of less than two hours, so it’s a solid choice for people dealing with intense nausea and vomiting during migraines, which can make taking tablets difficult for immediate relief.

4. Reyvow (lasmiditan)

Reyvow (lasmiditan)  is a member of yet another prescription drug class available for the acute treatment of migraine headaches, known as selective serotonin 5-HT(1F) agonists. This class of medications are excellent alternatives for individuals unable to take other medication classes, like triptans, due to contraindications like coronary heart disease or a history of stroke. Triptans‘ mechanism of action includes binding 5-HT(1B) and 5-HT(1D), which also participate on a small scale in cardiac blood vessel constriction. Studies have demonstrated no activation of 5-HT(1F) receptors in peripheral arteries, resulting in the management of migraine without causing vasoconstriction. Reyvow is available in 50 mg, 100 mg, and 200 mg single doses and provides a quick onset of action in 20 to 40 minutes. This class of drugs does pose a risk for the development of serotonin syndrome, either by itself or if taken in combination with other serotonergic drugs, including triptans and antidepressants like selective serotonin receptor inhibitors (SSRIs). 

5. Trudhesa (dihydroergotamine)

Trudhesa is a dihydroergotamine nasal spray and is a good option for individuals who respond poorly to first-line medications or who experience prolonged migraines. Like most other acute management options that only allow a single repeated second dose, Trudhesa can only be administered as a maximum of two doses (four sprays) in 24 hours. Like Ubrelvy, it is also contraindicated in severe kidney or liver impairment and cannot be taken with medications known as strong CYP3A4 inhibitors. Trudhesa carries a boxed warning stating that combining it with certain strong CYP3A4 inhibitors can lead to severe and life-threatening peripheral ischemia. Due to these safety concerns, using them together is not recommended. 

The potential benefit of Trudhesa for certain individuals is its onset of action, which is very quick, at 15 minutes. Ubrelvy’s onset of action can be up to two hours. In addition, Trudhesa’s half-life is longer than some other medication options, coming in at 12 hours, which may allow for its benefit in those who experience prolonged migraines. A pivotal phase 3 clinical trial, STOP 301, showed that the novel technology used for administration provided rapid and reliable symptom relief, allowing patients to return to their daily tasks.

RELATED: When to talk to your doctor about a prescription for migraine

Natural alternatives to Ubrelvy

While medications are a core component of migraine management, lifestyle modifications may also play a role in the prevention of migraine. Some strategies to incorporate include adequate sleep, minimizing stress, maintaining hydration, a well-balanced diet, exercise, and avoidance of known triggers. For some individuals, caffeine may stop a migraine attack, as demonstrated by a small study showing that caffeine was better than placebo in relieving some types of headaches. However, the greatest benefit of caffeine is likely to occur in those who sparingly consume it daily, as the brain can develop a tolerance. Magnesium supplements were given a Level B rating for preventive migraine therapy by the American Headache Society, meaning they are considered effective in this role, presumably by stabilizing excitatory neurotransmitters. CoQ10 supplementation plays a role in energy metabolism in the brain and may, therefore, reduce migraine frequency. Feverfew has shown an ability to reduce the frequency and duration of migraine attacks, while melatonin may be effective in preventing them altogether. 

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How to switch to a Ubrelvy alternative

Fortunately, switching to Ubrelvy alternatives is not a great feat. The available medications for acute management of migraines generally have short half-lives, so after a day or two of a prior dose, an alternative could be tried. Also, since CGRP blockers are not associated with the rebound headache phenomenon, stopping and starting a new class of medication should not exacerbate the number of types of migraines experienced at baseline. It is important to remember that other medications taken for conditions besides migraines may interact with Ubrelvy alternatives, so a complete medication list should always be thoroughly reviewed with a healthcare provider before any transition. 

If an individual does not have great success in the acute treatment of their migraine attacks, another approach is the use of preventive medications designed to stop migraine attacks from starting. CGRP monoclonal antibodies (MABs) are the first preventive medications to prevent migraines. CGRP MABs include Aimovig (erenumab), Ajovy (fremanezumab), and Emgality (galcanezumab), which are administered by self-infection every month. Vyepti (eptinezumab) is another prophylactic CGRP monoclonal antibody administered by IV infusion every three months. Qulipta (atogepant) and Nurtec (rimegepant) are CGRP inhibitors approved for both episodic and chronic migraine prevention.