Nurtec (Rimegepant): A Gepant Treatment for Migraine Relief

Introduction to acute treatment in migraine

Migraine is a complex brain disorder that causes recurrent episodes involving head pain, nausea, and/or sensitivity to light and/or sound among other debilitating symptoms. Migraine episodes can last between 4-72 hours when untreated, and are often very disabling.

Migraine treatment is divided into:

• acute: treating the individual migraine episodes
• preventive: aiming to prevent an episode from developing

Both acute and preventive treatment can consist of pharmacological as well as non-pharmacological options. To ensure acute treatment works effectively it is important to choose the appropriate therapy, dose, route of administration, and identify the correct time to take it as doses taken early have the best outcomes.

The aim of acute treatment is to (1):

• provide rapid and sustained relief of head pain and the most bothersome symptoms within two hours
• restore functional ability
• minimize rescue medication use 
• reduce side effects

There are a variety of medications available for the acute treatment of migraine, however the same treatment may not work for every person. Finding the right medication depends on having the right diagnosis, any other health conditions or medications, and the nature and severity of your symptoms. (2)

Your doctor can also help you to manage lifestyle triggers and comorbidities. Addressing lifestyle factors is an important early step of treatment, and can ensure you are taking the medication best suited to the severity and frequency of your episodes (3). 

What is Nurtec (Rimegepant)?

Nurtec (rimegepant) is part of a class of medications called “gepants”. Gepants are a class of drugs specifically designed to treat migraine episodes by blocking the action of a protein involved in pain,  inflammation and vasodilation, called CGRP. CGRP is a protein that is widely distributed throughout the body, however its presence in the trigeminal nerve ganglion, dural blood vessels (the layer covering the brain) and other pain centres in the brain is central to its role in migraine. (4, 5)

Identification of CGRP’s involvement in migraine was a revolutionary pivot point in migraine research. Research has shown that elevated levels of CGRP are found in individuals during migraine episodes, and its inhibition can lead to relief from migraine symptoms, leading to the development of CGRP inhibitors, the monoclonal antibodies, and gepants for use in migraine management.

Gepants are currently used as a second-line treatment when triptans are ineffective or contraindicated, and have the potential to significantly improve the quality of life for people who experience migraine in Australia.

It is essential for patients to consult with their doctor to determine the most appropriate treatment plan for their individual needs. By staying informed about the latest advancements in migraine, patients can take an active role in managing their condition and improving their quality of life.  

NURTEC ODT is indicated for acute treatment of migraine with or without aura in adults; and for prophylactic treatment of episodic migraine  (between 4 and 15 migraine days per month) in adults.

Nurtec at a glance

Access and Cost in Australia

Access

Rimegepant was submitted to the TGA in September 2022, and was listed on the ARTG in July 2023. It is currently available with a private prescription in Australia, but is not subsidised by the PBS. (6)

Rimegepant was evaluated in the July 2023 PBAC meeting. It was submitted for acute treatment in people who have not responded adequately to at least 2 triptans. While it was not recommended for listing in this initial submission, the PBAC did encourage them to re-submit.

As of July 2025, the manufacturer is still seeking PBS listing, and they are in negotiations with the PBAC to find a favourable pricing agreement. We hope to hear the outcome of these negotiations soon.

Cost

Nurtec rimegepant tablets are available in Australia for those who are diagnosed with migraine, with or without aura. It is available on private prescription under Schedule 4 (prescription only).

The cost varies between pharmacies, however an estimate in July 2025 is  2 x 75mg tablets for $62, with a prescription from your doctor. You are also able to purchase a packet of 8 x 75mg tablets for $243.

How Nurtec Works

Our brain does not have the ability to feel pain. Instead, the nerves, including the trigeminal nerve, pass the sensation of pain on the brain’s behalf. The trigeminal nerves are the nerves around the head which are responsible for sensations in the face, head and motor functions such as chewing.

During a migraine headache, CGRP is released and binds to receptors in the trigeminal nerves which leads to pain.

Gepants work by blocking CGRP receptors. By binding to the CGRP receptor, gepants prevent the interaction between CGRP and its receptor in the trigeminal nerve, disrupting the pain signalling pathway associated with migraine episodes. This results in reduced inflammation, blood vessel dilation, and the transmission of pain signals in the brain. Patients experience relief from migraine symptoms, including headache, nausea, and sensitivity to light and sound.

Dosage and Administration 

Recommended Dose

For acute treatment of migraine, the recommended dose is rimegepant 75 mg as needed, with a maximum of 75 mg in 24 hours.

For prophylaxis of migraine, the recommended dose is rimegepant 75 mg every other day. 

Nurtec can be used for acute or preventive treatment in one day, but not for both, do not exceed the maximum dose of 75mg in 24 hours.

You should not exceed eighteen days use per month.

How and When to Take It (7)

Nurtec ODT is for oral use. Nurtec ODT can be taken with or without food or water.

1. Use dry hands when opening. Peel back the foil covering of one blister and gently remove the tablet. Do not push the tablet through the foil.

2. As soon as the blister is opened, remove the tablet and place it on or under the tongue, where it will dissolve. No drink or water is needed. Do not store the tablet outside the blister for future use.

Other information

If you take Nurtec ODT for the prevention of migraine and it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to. Do not take a double dose to make up for the dose you missed. 

If you experience severe nausea due to the migraine episode and find it difficult to take tablets, you should speak to your doctor about other medication options, or combining Nurtec with an anti-nausea medication.

If you think that you have used too much Nurtec ODT, you may need urgent medical attention, even if there are no signs of discomfort or poisoning. In this case, you should immediately phone the Poisons Information Centre (13 11 26), contact your doctor, or go to the emergency department at your nearest hospital (8).

Nurtec may interact with some medications, and it is important to speak to your doctor about whether this medication is appropriate for you with consideration to your other health conditions, and any other medications you take.

How effective is Nurtec?

Rimegepant (Nurtec) has been shown to effectively treat and prevent migraine episodes in adults with episodic migraine (fewer than 15 days of migraine per month).

Acute Treatment Efficacy

A large double-blind, randomised, placebo-controlled, multicentre phase 3 trial for Nurtec (rimegepant) involved 1,466 participants. Some of the key findings include (9):

• Freedom from pain at 2 hours post-dose:
  
  • Rimegepant: 21%
    
  • Placebo: 11%
• Freedom from the most bothersome symptom (nausea, photophobia, or phonophobia) at 2 hours:
  
  • Rimegepant: 35%
    
  • Placebo: 27%
    

Symptom Relief

Across four large clinical trials (totaling over 4,800 participants) (10):

• Up to 21% of people were completely pain-free at 2 hours after taking rimegepant.
• For other symptoms like nausea, light or sound sensitivity, up to 50% of people had relief within 2 hours.

Safety and Tolerability

• Rimegepant was generally well-tolerated, with a favourable safety profile.
• Most common side effects:
  • Nausea: 2% with rimegepant vs 1% with placebo
    
  • Urinary tract infection: 1% in both groups
    
• No serious adverse events were reported among those treated.
  

Rimegepant offers modest relief for the acute treatment of migraine.
While it is more effective than placebo, the improvements are mild for many, and not everyone responds to the treatment.

Preventive Treatment Efficacy (11)

• Rimegepant was studied as a preventive treatment for people with 4 to 18 migraine days per month (median = 8).
• In a clinical trial with 747 participants, rimegepant 75 mg was taken every other day for 12 weeks.
• Compared to placebo, rimegepant led to 0.8 fewer migraine days per month (average of 4.3 days vs. 3.5 days).
• The reduction was statistically significant, but modest overall.
• There was no significant difference in the need for rescue medication, although people taking rimegepant used slightly less.

Rimegepant 75 mg (oral) has been shown to be effective for treating migraine in people who don’t respond well to triptans, as well as in those who currently use triptans or haven’t tried them before. A deeper analysis of data from three phase 3 clinical trials found that rimegepant worked well across all groups—whether people had tried one or multiple triptans without success, or were still using them. (12)

Overall, rimegepant offers modest benefit compared with placebo for acute treatment or prophylaxis of migraine. It may serve as an alternative option when other migraine therapies are ineffective, contraindicated or not tolerated. 

It is important to note that the efficacy of Nurtec may vary among individuals, and the choice of treatment should be tailored to each patient’s specific needs and medical history with their doctor.

Comparison with Triptans

Triptans remain one of the most effective acute migraine treatment for many people, with higher response rates compared to gepants. (13) However, triptans work by constricting blood vessels, which means they may not be suitable for people with cardiovascular disease.

Gepants like Nurtec (rimegepant) act differently—by blocking CGRP receptors without causing vasoconstriction—making them a safer option for those with vascular concerns. They are generally well tolerated and may carry a lower risk of medication overuse headache, although data in people with significant cardiovascular disease remain limited, so treatment choice should always be discussed with your doctor.

Side effects

Nurtec has a favourable safety profile, with reported side effects generally being mild and transient, and occurred at similar rates as placebo. (7)

So far, no evidence suggests rimegepant causes medication overuse headache.

Warnings & Risks

Medication overuse headache

Medication overuse headache (MOH) can occur when acute migraine treatments—like pain relievers or triptans—are used too often. Instead of improving symptoms, overuse can lead to more frequent headaches and make medications less effective, and it is a known contributor to chronic daily headache.

Gepants have not shown any evidence of contributing to MOH. Therefore they may be useful for those with frequent migraine episodes. (7)

Health conditions that may not be appropriate for Nurtec

Rimegepant can usually be taken safely by people with mild to severe kidney problems, but it should be avoided if you have very poor kidney function or end-stage kidney disease. Rimegepant should not be used in patients with severe hepatic impairment. (7)

There isn’t much safety data yet on using rimegepant in people with heart disease, as clinical trials mostly excluded those with serious or unstable heart conditions, high blood pressure, or uncontrolled diabetes. Experts are cautious because blocking CGRP (the target of this medication) over the long term theoretically might reduce the body’s ability to widen blood vessels during a heart-related event. Because of this, doctors recommend careful use of rimegepant in people with heart conditions. (14)

Clinical trials for acute and preventive migraine treatments excluded people with recent or unstable cardiovascular conditions, including heart attack, stroke, or major cardiac procedures within the past 6 months.

Pregnancy & Breastfeeding

There is limited data for CGRP inhibition in pregnancy and breastfeeding, and as such it is generally not recommended. Speak to your doctor about specific advice for yourself. (7)

Things to consider when taking Nurtec (7)

Tell any other doctors, dentists, and pharmacists who are treating you that you are taking Nurtec ODT. If you are about to be started on any new medicine, tell your doctor, dentist or pharmacist that you are taking Nurtec ODT.

If you become pregnant while taking Nurtec ODT, tell your doctor.

Things you should not do:

• Do not give Nurtec ODT to anyone else, even if they have the same condition as you. 
• Do not take Nurtec ODT to treat any other complaints unless your doctor or pharmacist tells you to. 
• Do not stop taking Nurtec ODT, or change the dosage, without checking with your doctor or pharmacist. 
• Migraine episodes may cause drowsiness in some people. Caution is recommended if driving or using machines during a migraine episode, including after taking Nurtec ODT.

Nurtec is also not suitable for anyone who is allergic to it, or allergic or hypersensitive to other ingredients in the medication. You can find a full list of ingredients in the Consumer Medicine Information leaflet. (8)

Precautions and Interactions

Rimegepant is metabolised in the body by the enzyme CYP3A4. Medicines that strongly inhibit or enhance this enzyme can alter how rimegepant is processed, so these should be avoided. If taken with moderate CYP3A4 inhibitors or strong P-glycoprotein blockers, you should avoid another dose within 48 hours. (7)

Some common medications that may interact with rimegepant are listed below, however it is important to discuss with your doctor to obtain specific advice.

Avoid taking Nurtec ODT with the following medicines (8):

Antibiotics / Antifungals

• Itraconazole
• Clarithromycin

HIV / COVID Treatments

• Ritonavir (Paxlovid)
• Efavirenz

Other Prescription Medicines

• Bosentan (used for high blood pressure)
• Phenobarbital (used for epilepsy)
• Rifampicin (used for tuberculosis)
• Modafinil (used for narcolepsy)

Supplements / Herbal Remedies

• St. John’s Wort (used for depression)

Do not take Nurtec ODT more than once every 48 hours if also taking: (8)

Antibiotics / Antifungals

• Fluconazole
• Erythromycin

Heart / Blood Pressure Medications

• Diltiazem
• Quinidine
• Verapamil

Immunosuppressants

• Ciclosporin (used after organ transplant)

These medicines may be affected by Nurtec ODT or may affect how well it works. You may need different amounts of your medicine, or different medicines. Check with your doctor or pharmacist if you are not sure about what medicines, vitamins or supplements you are taking and if these affect Nurtec ODT.

Further information & resources

If you would like to learn more about migraine or different treatment options, you may find the following articles helpful.

• • Migraine – a comprehensive article about migraine symptoms, causes, treatments, and more.
  • Acute Migraine Medication – article summarising other types of acute migraine medication, including a general overview of other triptans. 
  • Treatment directory – overview article including a brief explanation of the medications available to treat migraine and different classes of treatment.
  • Gepants – overview of all gepants in the market and available in Australia
  • Understanding and Managing the Psychological Impact– article exploring the less visible impacts of living with migraine, offers practical, evidence-informed strategies to help people living with migraine not just cope, but live well
  • Strategies to Help Prevent the Progression from Episodic to Chronic Migraine – article exploring the factors that play a role in migraine chronification and strategies for prevention.

References:

1. Peter Goadsby, The Latest New Treatment Innovations. Migraine World Summit, 2020. Accessed 2025 from:  https://migraineworldsummit.com/talk/the-latest-new-treatment-innovations/ 
2. WJ Becker, 2015, Acute Migraine Treatment in Adults. https://doi.org/10.1111/head.12550 
3. B Jenkins, 2020, Migraine management. https://doi.org/10.18773/austprescr.2020.047
4. Ray JC, Kapoor M, Stark RJ, Wang SJ, Bendtsen L, Matharu M, Hutton EJ. Calcitonin gene related peptide in migraine: current therapeutics, future implications and potential off-target effects. J Neurol Neurosurg Psychiatry. 2021 Dec;92(12):1325-1334. doi: 10.1136/jnnp-2020-324674
5. Peter Goadsby, Migraine Biochemistry: CGRP & Beyond, Migraine World Summit 2024. Accessed 2025 from: https://migraineworldsummit.com/talk/migraine-biochemistry-cgrp-beyond/  
6. Pharmaceutical Benefits Scheme. Accessed 2025 from: https://www.pbs.gov.au/medicine/item/8266C
7. Therapeutics Goods Administration, Australian Government, Product Information. Accessed 2025 from:  https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2023-PI-01961-1 
8. Therapeutics Goods Administration, Australian Government, Consumer Medicine Information. Accessed 2025 from:  https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2023-CMI-02415-1&d=20250721172310101 
9. Croop, R., Goadsby, P. J., Stock, D. A., Conway, C. M., Forshaw, M., Stock, E. G., … & Lipton, R. B. (2019). Efficacy, safety, and tolerability of rimegepant orally disintegrating tablet for the acute treatment of migraine: a randomised, phase 3, double-blind, placebo-controlled trial. The Lancet, 394(10200), 737-745. DOI: 10.1016/S0140-6736(19)31606-X
10. Yu S, Kim BK, Guo A, Kim MH, Zhang M, Wang Z, et al. Safety and efficacy of rimegepant orally disintegrating tablet for the acute treatment of migraine in China and South Korea: a phase 3, double-blind, randomised, placebo-controlled trial. Lancet Neurol 2023;22:476-84 doi: 10.1016/S1474-4422(23)00126-6 
11. Croop R, Lipton RB, Kudrow D, Stock DA, Kamen L, Conway CM, et al. Oral rimegepant for preventive treatment of migraine: a phase 2/3, randomised, double-blind, placebo-controlled trial. Lancet 2021;397:51-60. Doi: 10.1016/S0140-6736(20)32544-7 
12. Lipton RB, Blumenfeld A, Jensen CM, et al. Efficacy of rimegepant for the acute treatment of migraine based on triptan treatment experience: Pooled results from three phase 3 randomized clinical trials. Cephalalgia. 2023;43(2). doi:10.1177/03331024221141686
13. Karlsson W K, Ostinelli E G, Zhuang Z A, Kokoti L, Christensen R H, Al-Khazali H M et al. Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysis BMJ 2024; 386 :e080107 doi:10.1136/bmj-2024-080107
14. Australian Prescriber, Rimegepant for migraine, 2024. Doi: 10.18773/austprescr.2024.029
15. The Association for Migraine Disorders. Gepants for Migraine Disease, Explainer video series, 2023. Accessed 2025 from: Gepants for Migraine Disease