Sylvia ODT

Indications

Rimegepant is used in adults to treat migraine attacks, with or without aura, once they have started. It is also used to help prevent episodic migraine (migraine on fewer than 15 days a month). It is not used for other kinds of headache.

How It Works

During a migraine, a nerve chemical called CGRP (calcitonin gene-related peptide) is released around the brain and widens blood vessels, causing pain and inflammation. Rimegepant blocks the receptor that CGRP acts on, which helps relieve the headache and related symptoms such as sensitivity to light and sound, and, with regular use, can reduce how often attacks happen.

Dosage and Administration

• To treat an attack: the usual adult dose is 75 mg once, taken as soon as possible after the migraine starts.
• To prevent migraine: 75 mg every other day, if your doctor advises.
• Do not take more than 75 mg in 24 hours.
• The orally disintegrating tablet is placed on or under the tongue, where it melts; it can be taken with or without water. Handle it with dry hands and take it straight out of the pack.

Interactions

Avoid use with strong CYP3A4 inhibitors such as Ketoconazole, Itraconazole, Clarithromycin and Ritonavir, as they raise Rimegepant levels a lot. Do not take a second dose within 48 hours when using moderate CYP3A4 inhibitors such as Fluconazole, Diltiazem or Erythromycin. Avoid strong or moderate enzyme inducers such as Rifampicin, Carbamazepine, Phenytoin and St John's wort, which can make it work less well. Strong P-glycoprotein inhibitors such as Ciclosporin and Quinidine should also be avoided. Grapefruit juice may raise its levels.

Contraindications

Do not use if you are allergic to Rimegepant or any ingredient of the tablet. It is not recommended in severe liver disease or in end-stage kidney disease.

Side Effects

The most common side effect is nausea. Some people have stomach pain, indigestion or tiredness. Allergic reactions such as rash, itching or shortness of breath can occur, sometimes days after taking it. A rise in blood pressure or Raynaud's phenomenon (cold, pale or painful fingers and toes) has been reported with medicines of this group.

Get urgent medical help if you develop swelling of the face, lips or throat, difficulty breathing, a severe rash, or if your headache is sudden, very severe or unlike your usual migraine.

Pregnancy and Lactation

There is limited information on use in pregnancy, so it is best avoided unless your doctor decides it is needed. Only small amounts pass into breast milk; discuss with your doctor before using it while breastfeeding.

Precautions and Warnings

• Use only after a doctor has confirmed migraine as the cause of your headaches.
• Tell your doctor about liver or kidney disease, high blood pressure or circulation problems.
• Not approved for children and adolescents.
• Keep a headache diary; if you need treatment very often, see your doctor.

Overdose

There is little experience of overdose. If too much has been taken, contact a doctor or poison centre. Treatment is supportive with monitoring.

Therapeutic Class

Antimigraine medicine, CGRP receptor antagonist (gepant)

Storage

Store below 30°C in a dry place in the original pack to protect from moisture and light. Keep out of the reach of children.