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calcitonin gene receptor peptide (CGRP) blockers

Introduction

CGRP is a peptide in the brain that causes pain, inflammation, and blood vessel dilation during a migraine attack
CGRP blockers are agents which can block the actions of this peptide and can be used to help prevent as well as treat acute migraine attacks
unlike triptans they do not cause vasoconstriction (vasoconstriction may exacerbate cerebral ischaemia)
they usually have the suffix gepant
in 2018, US FDSA approves Aimovig, a parenteral calcitonin gene–related peptide (CGRP) blocker for prophylaxis of migraine
in Dec 2019, US FDA approves Ubrogepant (Ubrelvy), an oral calcitonin gene–related peptide (CGRP) blocker for Rx of acute migraine

rimegepant
- taken as a 75 mg orally disintegrating tablet that dissolves under the tongue without water at the very first sign of migraine attack
- do not exceed one 75 mg dose in any 24-hour period
- adverse effects include nausea, indigestion, or abdominal pain, or drowsiness but these generally only occur ~2% of the time
- avoid or use with care in those with severe hepatic or renal impairment
- as of 2026, not on PBS in Australia but available on private prescription but costs about $AU30 per 75mg tablet