How do Ubrelvy, Qulipta and Nurtec compare for migraines?
Ubrelvy, Qulipta and Nurtec ODT are all medicines used by adults for migraines.
They are all from the same group of medicines often called gepants but their full name is calcitonin gene-related peptide (CGRP) receptor antagonist.
Are they taken to treat or prevent a migraine?
- Ubrelvy is used to treat migraines with or without aura.
- Qulipta is taken to prevent migraines.
- Nurtec ODT is taken to treat migraines with or without aura and also to prevent episodic migraines.
How do you take them?
- Ubrelvy and Qulipta are tablets that you swallow with a drink.
- Nurtec ODT is a tablet that is placed on or under the tongue to disintegrate.
How well do they work to treat an acute migraine?
In their own individual drug clinical trials, more of the Nurtec ODT patients were pain free but more of the Ubrelvy patients were free from their most bothersome symptoms (MBS) e.g. light sensitivity, sound sensitivity, or nausea. In the clinical trials, two hours after treatment patients who were:
Pain free
- 7.4% more of the 50mg Ubrelvy patients and 9.4% of the 100mg Ubrelvy patients were pain free, when compared to placebo.
- 10.3% more of the Nurtec ODT patients were pain free, when compared to placebo.
Most bothersome symptoms (MBS)
- 10.8% more of the 50mg Ubrelvy patients and 9.4% of the 100mg Ubrelvy patients were free from their most bothersome symptoms (MBS) when compared to placebo.
- 8.3% more of the Nurtec ODT patients were free from MBS, when compared to placebo.
How well do they work to prevent migraines?
The separate individual clinical trials Qulipta patients had a bigger decrease in monthly migraine days when compared against the Nurtec ODT clinical trial. In the Nurtec ODT clinical trial they also looked at patients that had at least a 50% decrease in the number of moderate to severe monthly migraine days and Nurtec ODT reduced this by 7.6%, when compared to placebo.
Decrease in monthly migraine days
- Qulipta decreased monthly migraine days for 10mg dose decreased by 1.2 days, 30mg by 1.4 days and 60mg decreased by 1.7 days, when compared to placebo.
- Nurtec ODT decreased the monthly migraine days by 0.8 days.
Reduction in moderate to severe monthly migraine days (patients who had a least a 50% decrease)
- Nurtec ODT compared to placebo reduced moderate to severe monthly migraine days by 7.6%.
How often do you need to take them?
Ubrelvy is taken when you have a migraine and again in two hours if you need to. In some cases you can only take one tablet. It is unknown if it is safe to treat more than 8 migraines over 30 days.
Qulipta is taken to prevent migraines and is taken once a day with or without food.
Nurtec ODT is taken when you have a migraine (one tablet only over a 24 hour period), with a maximum of 18 tablets over 30 days. To prevent migraines, one tablet of Nurtec ODT is taken every other day.
How do the side effects compare?
Nausea
Ubrelvy, Qulipta and Nurtec ODT tablets all had nausea as a side effect. Nurtec ODT (acute treatment) and Ubrelvy 50mg had the least amount of nausea having only 2% patients with nausea. Nurtec ODT for preventative treatment had 2.7% of patients with nausea, Ulbrelvy 100mg was 4%, and Qulipta had 5% to 9% of patients with nausea over the 3 different strengths.
- Nurtec ODT 2% (acute treatment), 2.7% (preventative treatment).
- Ubrelvy 50mg 2%, Ubrelvy 100mg 4%.
- Qulipta 10mg 5%, Qulipta 30mg 6%, Qulipta 60mg 9%.
Fatigue
Both Ubrelvy and Qulipta have fatigue as a side effect, Ubrelvy had less fatigue than Qulipta.
- Ubrelvy 50mg 2%, Ubrelvy 100mg 3%.
- Qulipta 10mg 4%, Qulipta 30mg 4%, Qulipta 60mg 6 %.
Other side effects
- Dry mouth, Ubrelvy 100mg 2%.
- Constipation, Qulipta 6% for all strengths.
- Weight loss, Qulipta 10mg 3.8 %, Qulipta 30mg 3.2%, Qulipta 60mg 4.9 %.
- Stomach upset Nurtec ODT 2.4% (preventative treatment).
What important drug interactions or medical conditions that need dose changes?
All three of the migraine medications have drug interactions which need dose changes to the migraine medication or require you NOT to take the migraine medication. This is a small example of drug interactions. For more information check drug interactions.
CYP3A4 inhibitors and inducers
- Ubrelvy, Nurtec ODT and Qulipta interact with this group of medications, so you may need to change your migraine medication dose or not take the migraine medication at all.
BCRP and/or P-gp Inhibitors
- Ubrelvy and Nurtec ODT requires a change in dose.
OATP inhibitor
- Qulipta requires a change in dose.
Medical Conditions
All three of the migraine medications may need to be avoided or their dose changed if there is liver or kidney impairment, depending on how bad the liver or kidney function is and which migraine medication you are taking.
Table comparing Ubrelvy, Qulipta and Nurtec ODT
| Ubrelvy (ubrogepant) | Qulipta (atogepant) | Nurtec ODT (rimegepant) | |
| Use (Adults) | Treat migraine headaches with or without aura | Prevent migraine |
Treat migraine attacks, with or without aura Prevent episodic migraine. |
| Form | Tablet (swallow with a drink) | Tablet (swallow with a drink) | Oral disintegrating tablet (placed under or on the tongue) |
| Dose |
50mg or 100mg tablet when migraine occurs another dose may be taken in 2 hours if required, under certain conditions. Maximum dose of 200mg in 24 hours. Treating more than 8 migraines over 30 days has NOT been established as safe |
10 mg, 30 mg, or 60 mg tablets. Once daily with or without food. |
Treatment migraine: 75 mg tablet up to once daily for migraine (Maximum of 18 tablets in a 30 day period. Prevent migraine: 1 tablet every other day |
| Dose changes needed |
Specific drugs: Weak and Moderate CYP3A4 Inhibitors Weak & Moderate CYP3A4 Inducers BCRP and/or P-gp only Inhibitors Medical Conditions: Severe Hepatic Impairment (Child-Pugh Class C) Severe Renal Impairment (CLcr 15-29 mL/min) |
Specific drugs: Strong CYP3A4 inhibitors Strong and Moderate CYP3A4 inducers OATP inhibitor Medical conditions: Severe renal impairment (CLcr 15-29 mL/min) End-stage renal disease (CLcr <30 mL/min) |
Specific drugs: Moderate inhibitors of CYP3A4 Inhibitors of P-gp |
| Avoid |
Avoid concomitant use with Strong CYP3A4 Inducers Avoid use with End-Stage Renal Disease (CLcr <15 mL/min) |
Avoid use with Severe hepatic impairment |
Specific drugs: Avoid concomitant administration with Strong CYP3A4 inhibitors Avoid concomitant administration Strong and moderate CYP3A Inducers Medical conditions: Avoid use with Severe hepatic impairment Avoid use with end-stage renal disease |
| Contraindications |
Specific drugs: Strong CYP3A4 Inhibitors |
No contraindications |
Patients: With a history of hypersensitivity reaction to rimegepant, Nurtec or any ingredients |
|
How effective are they? (drug effect - placebo effect = treatment effectiveness) |
Treating migraine: 2 hours after treatment Pain free 50mg Ubrelvy patients who were pain free compared to placebo = 7.4% (19.2%-11.8 % = 7.4%) 100mg Ubrelvy patients who were pain free compared to placebo = 9.4 % (21.2%-11.8% = 9.4%) Most bothersome symptoms (MBS) 50mg Ubrelvy patients who were free from MBS compared to placebo = 10.8% (38.6%-27.8% = 10.8%) 100mg Ubrelvy patients who were free from MBS compared to placebo = 9.4% (38.6%-27.8% = 10.8%) |
Preventing migraine: after 12 weeks treatment Decrease in monthly migraine days compared to placebo Qulipta 10mg -1.2 days (-3.7- -2.5 = -1.2 days) Qulipta 30mg -1.4 days (-3.9- -2.5 = -1.4 days) Qulipta 60mg -1.7 days (-4.2- -2.5 = -1.7 days) Decrease in acute medication days compared to placebo Qulipta 10mg -1.3 days (-3.7- -2.4 = -1.3 days) Qulipta 30mg -1.3 days (-3.7- -2.4 = -1.3 days) Qulipta 60mg -1.5 days (-3.9- -2.4 = -1.5 days) |
Treating migraine: 2 hours after Nurtec ODT 75mg treatment Patients who were pain free compared to placebo = 10.3% (21.2%-10.9% = 10.3%) Patients who were free from most bothersome symptom compared to placebo = 8.3% (35.1%-26.8% = 8.3%) Preventing Migraine: results from week 9 to week 12 of trial, 75mg alternate days Decrease in monthly migraine days (MMD) compared to placebo Nurtec ODT reduced MMD by -0.8 days (-4.3- -3.5 = -0.8 days) Reduction in moderate to severe monthly migraine days (patients who had a least a 50% decrease) Nurtec ODT compared to placebo reduced moderate to severe monthly migraine days by 7.6% (49.1%-41.5% = 7.6%) |
| Side Effects |
Nausea: Placebo 2% Ubrelvy 50mg 2% (0% more than placebo) Ubrelvy 100mg 4% (2% more than placebo) Sleepiness & Fatigue Placebo 1% Ubrelvy 50mg 2% (1% more than placebo) Ubrelvy 100mg 3% (2% more than placebo) Dry Mouth: Placebo 1% Ubrelvy 50mg <1% (less than placebo) Ubrelvy 100mg 2% (1% more than placebo) |
Nausea: Placebo 3% Qulipta 10mg 5% (2% more than placebo) Qulipta 30mg 6% (3% more than placebo) Qulipta 60mg is 9% (6% more than placebo) Fatigue Placebo 3% Qulipta 10mg 4% (1% more than placebo) Qulipta 30mg 4% (1% more than placebo) Qulipta 60mg 6 % (3% more than placebo) Constipation Placebo 1% Qulipta 10mg 6 % (5% more than placebo) Qulipta 30mg 6% (5% more than placebo) Qulipta 60mg 6 % (5% more than placebo) Weight loss: (of at least 7 %) Placebo 2.8% Qulipta 10mg 3.8 % (1% more than placebo) Qulipta 30mg 3.2% (0.4% more than placebo) Qulipta 60mg 4.9 % (2.1% more than placebo) |
Acute treatment: Nausea: Placebo 0.4% Nurtec ODT 2%. (1.6% more than placebo) Preventaive Treatment: Nausea Placebo 0.8% Nurtec ODT 2.7% (1.9% more than placebo) Abdominal pain/dyspepsia Placebo 0.8% Nurtec ODT 2.4% (1.6% more than placebo) |
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Bottom line:
- Ubrelvy, Qulipta and Nurtec ODT are all medicines used by adults for migraines.
- Ubrelvy and Nurtec ODT are used to treat migraines with or without aura.
- Nurtec ODT taken to prevent episodic migraines..
- Qulipta is taken to prevent episodic and chronic migraines.
- The ideal choice of migraine medication will depend on your personal medical history, of type of migraine, frequency of migraines, symptoms of migraines, current medications and medical conditions.
References
- Nurtec Professional Medication Information [Accessed October 13, 2021] https://www.drugs.com/pro/nurtec-odt.html
- Ubrelvy Professional Medication Information [Accessed October 13, 2021] https://www.drugs.com/pro/ubrelvy.html
- Qulipta Prescribing Information: [Accessed October 13, 2021] https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/215206Orig1s000lbl.pdf
- Qulipita Prescribing Information: updated 4/2023 [Accessed May 3, 2023] https://www.rxabbvie.com/pdf/qulipta_pi.pdf
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