Ask the Pharmacist

Q) I read somewhere that there is a brand new type of drug that has just been introduced to treat migraines. What can you tell me about it?

A) Ubrelvy (ubrogepant) is the first drug in a new class of agents that will aim at treating acute migraines as opposed to preventing them. As such, it will be an alternative to standard pain killers such as Tylenol/ acetaminophen, NSAIDs (such as Advil/ ibuprofen) and the “triptans” such as Imitrex/ sumatriptan and Maxalt/ rizatriptan.

It’s a welcome alternative as there are still many migraine sufferers who can’t take any of the already available alternatives due to side effects or the presence of other health conditions they are also afflicted with, such as cardiovascular disease. There are also many who find the current options do not provide adequate relief.

Migraines enact a tremendous toll on the individual and on society. It is the third most prevalent disease in the world and approximately 8.3% of Canadians are estimated to be plagued by them. Migraines affect all demographics: 8% of females suffer from, 6% of men and 3% of children. Chronic migraines, a label that is attached for those with a headache for more than 14 days a month, afflict approximately 2% of the population. Migraines remain one of the most common reasons people miss work costing the economy and the individual in terms of future career progression and earnings. In the U.K. it is the second leading cause of short-term absence.

Ubrelvy is what is known as a “gepant”. It works by blocking the effects of calcitonin gene-related peptide (CGRP), a molecule that is released in our nerve cells during a migraine attack and has been proven to be involved in the process of dilating (widening) our blood vessels and increasing the sensitivity of our nerves to feeling pain. This is the same chemical that the injectable monoclonal antibodies, such as Aimovig and Ajovy that were released a few years ago, work on. The main difference between these two types of therapies is that drugs like Aimovig and Ajovy are designed to prevent migraines from occurring but have no role to play once a migraine has actually kicked in. That’s where acute treatments such Ubrelvy have a role to play.

Ubrelvy comes in the form of a tablet. At the onset of a migraine, a single 50mg or 100mg tablet is taken as soon as is possible. This dose may be repeated once every two hours after the initial dose if necessary. The maximum dose is 200mg in a 24 hour period.

Side effects seem to be fairly mild with the chief complaints being sleepiness, nausea and a dry mouth. There are also a number of potential interactions with other drugs that may require monitoring or potentially a change in dosage of one or the other drug. As to how well it works, about one in 10 patients are pain-free two hours after a dose of Ubrelvy versus using a placebo. This compares unfavourably with the triptans where a drug such as Imitrex has shown that it will allow one in 5 people to be pain-free after a couple of hours.

Ubrelvy is also more expensive than any of the other options further limiting its widespread usefulness. Beyond its role in patients who do not benefit or can’t take the other options, the other claim to fame for Ubrelvy is that, so far at least, it seems to be the one migraine treatment whose frequent use doesn’t lead to medication induced headaches. These medication induced headaches are perhaps the most common complication of migraine treatment and are extremely difficult and painful to manage if and when they set in. Medication induced headaches are caused by the use of drugs to treat them more than a few days a week. Examples of such medications are Advil, Tylenol, codeine and other opioids and the triptans. interestingly, these drugs do not cause this effect when they are used to treat other conditions such as arthritis. The end result of this condition is a chronic daily, dull headache which is accompanied by the episodic migraines the individual was originally treating. As you might guess, it is not a pleasant experience.

It’s nice to see new options available for migraine sufferers such as Ubrelvy. It will soon be joined by other drugs that work similarly such as Qulipta/atogepant that is expected to be on the market later this year. These new options will hopefully bring added improvements in terms of effectiveness or cost.

For more information about this or any other health related issues, contact your pharmacist.