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Is Ubrelvy better than triptans?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Oct 12, 2021.

Official answer

by Drugs.com

Overview

Head-to-head clinical studies of Ubrelvy and triptans are not available, but both are effective prescription medicines approved to treat acute migraine headaches with or without aura in adults. The best treatment for you may depend upon your previous treatments and side effects, migraine characteristics, and price.

Both Ubrelvy and triptans have been shown in studies to reduce migraine symptoms like headache pain, nausea, and sensitivity to light or sound and are taken at the first sign of pain. They are not used to prevent migraine attacks. Ubrelvy is associated with fewer side effects and warnings than triptans, but triptans are still safe, effective and more affordable for most patients.

Ubrelvy may be an effective treatment for your acute migraine if nonsteroidal antiinflammatory drugs (NSAIDs) or triptans do not work well, you cannot use NSAIDs or triptans, or you have intolerable side effects from these drug classes.

If you have significant nausea and vomiting with your migraine headaches, taking an oral treatment like Ubrelvy may not be the best approach. Speak with your doctor to review the best options for your specific migraine headaches.

Learn more: What are the new drugs for the treatment of migraines?

Ubrelvy vs. Triptans: How they work

Ubrelvy and triptans work in different ways to treat acute migraine pain.

Ubrelvy (ubrogepant) is in the class of drugs known as oral calcitonin gene-related peptide (CGRP) receptor antagonists, also known as gepants. CGRP is a protein that carries pain signals along nerves that cause the migraine headache pain

  • Ubrelvy is thought to work by directly blocking the CGRP protein that plays a role in migraine headaches by causing pain, dilation of blood vessels, and inflammation. CGRPs target the receptor on the sensory nerve.

Triptans are selective serotonin (5-HT1B/1D) receptor agonists and work by stimulating serotonin, a neurotransmitter found in the brain.

  • They reduce inflammation and constrict blood vessels, thereby stopping the acute migraine headache.

Studies with Ubrelvy and Triptans

In a large review of well-controlled studies published in 2021, researchers found that both triptans and CGRP antagonists like Ubrelvy work well in the acute treatment of migraine. This review did not directly compare tripants and CGRPs, but looked at individual studies compared to a placebo (an inactive substance).

Overall, both triptans and CGRP antagonists led to significantly increased freedom from pain or pain relief at an average of 2 hours after treatment. An increase in sustained pain freedom or relief was reported one day and one week after treatment for both classes, and improved or restored daily function occurred on average from 2 hours to one day later.

Both Ubrelvy and triptans are easy to take. They both come in an oral tablet form that you swallow. Triptans also come as injections and nasal sprays or powders, which may be an advantage if you experience severe nausea and vomiting with your migraine.

Ubrelvy vs. Triptans: Side Effects

Unlike triptans, Ubrelvy does not cause constriction of blood vessels; therefore, it may be safer for patients who cannot use triptans because of the risk of heart disease or other heart-related factors.

  • You may have a higher risk for heart disease if you have (or have a history of) high blood pressure, high cholesterol, smoke, are overweight or obese, have diabetes, or have a family history of heart disease.
  • Your doctor will assess your risk of heart disease before treating you with a triptan.

You may tolerate Ubrelvy better if you had side effects from triptans that caused you to stop treatment. Although head-to-head comparisons of side effects are not available, Ubrelvy appears to be very tolerable from a side effect standpoint based on clinical studies.

  • The most common side effects in studies with Ubrelvy were nausea and tiredness, occurring in roughly 2% to 4% of patients. Dry mouth may also occur infrequently.
  • About 2.5% (2.5 out of every 100) of patients stopped treatment in Ubrelvy studies because of side effects.
  • The most common reason for stopping treatment was nausea.
  • Ubrelvy was approved in 2019, more recently than most triptans, and some uncommon or rare side effects may not have been reported yet.

You may need to limit your dose if you take certain medications affected by liver enzymes or consume grapefruit or grapefruit juice. Your doctor may adjust your Ubrelvy dose if you have kidney or liver problems.

In general, triptans are also well-tolerated by most patients but are associated with more side effects and warnings than Ubrelvy. Not all side effects occur in everyone and some may be rare.

The most common side effects with sumatriptan (Imitrex) tablets, a commonly prescribed triptan, are tingling or numbness in your fingers or toes (paresthesia), warm or cold feeling, feeling weak, drowsy or tired, pain, discomfort, or stiffness in your neck, throat, jaw, or chest, and dizziness.

  • Some side effects of triptans are due to blood vessel constriction, which can be dangerous for patients with heart risks.
  • Most side effects occurred in 1% to 2% of patients, except for paresthesia and warm / cold feeling occurring in about 2% to 6% of patients.

Warnings for sumatriptan include a risk for heart attack or changes in heart rhythm, severe high blood pressure, bleeding in the brain, stroke, headaches due to medication overuse, reduced blood flow to the intestines, cautious use in patients with epilepsy or a lowered seizure threshold, and severe allergic reactions.

If you have a serious heart risk, your doctor may ask you to take your first triptan dose in a medically monitored setting.

Triptans also carry a rare risk of serotonin syndrome when used with certain antidepressants (SSRIs, SNRIs, TCAs or MAOIs) or when used within 24 hours of the use of ergotamine preparation or a different triptan medication.

  • Serotonin syndrome may appear as mental changes, fast heart rate, becoming overheated, nausea, vomiting and diarrhea.
  • To help avoid this risk, always have your pharmacist check for potential drug interactions with your prescription and over-the-counter medications.

Sumatriptan is not used to treat some other types of headaches such as hemiplegic (that make you unable to move on one side of your body) or basilar (rare form of migraine with aura) migraines.

Related: Treatment and Prevention Tips for Living with Migraine Headaches ​​

If you have significant nausea and vomiting with your migraine headaches, taking an oral treatment like Ubrelvy may not be the best approach. Triptans like sumatriptan or zolmitriptan are available in other dosage forms, such as subcutaneous (under the skin) injections, pens and nasal sprays, which may be preferable.

Subcutaneous injections dosage forms also offer a fast onset of action, and sumatriptan injection can be used for rescue treatment of uncontrolled headache pain.

Unlike Ubrelvy, some triptans are also used to treat other types of headaches, such as cluster headaches.

If you do not respond well to treatment with one triptan, you may respond to another.

Prescription medications in the triptan class include:

  • almotriptan (Axert, brand discontinued)
  • eletriptan (Relpax)
  • frovatriptan (Frova)
  • naratriptan (Amerge)
  • rizatriptan (Maxalt, Maxalt-MLT)
  • sumatriptan (Imitrex, Tosymra, Onzetra Xsail, Zembrace Symtouch)
  • zolmitriptan (Zomig, Zomig-ZMT)

Triptans combined with nonsteroidal antiinflammatory drugs (NSAIDS) are available and may be more effective than using either drug class alone. Treximet is a prescription tablet containing a combination of sumatriptan and naproxen available in a single pill.

Both Ubrelvy and triptans can have numerous drug interactions, and some drugs should not be combined with these treatments. Keep an updated list of your medicines, and tell your healthcare provider about all the drugs you take, including prescription and over-the-counter (OTC) medicines, vitamins, and herbal or dietary supplements.

Cost Factors

  • Most triptans are now available in a generic option and offer cost savings compared to the newer CGRPs like Ubrelvy.
  • In addition, your insurance may be more likely to pay for a generic triptan and may require you to use them before other newer options.
  • Ubrelvy is only available as a brand name drug. A generic version is not yet approved.

As a cost example for a triptan, the cash price for a supply of 9 oral 50 mg tablets of generic sumatriptan costs around $27, using a discount coupon. The injectable form and nasal spray options for sumatriptan are also available generically, but may be more expensive than the tablets.

The cash price for a supply of 10 oral tablets of Ubrelvy 50 mg is around $941, using a discount coupon. Allergan, the manufacturer of Ubrelvy, has a Savings Card that may lower your cost to $10 per month if you have commercial insurance and meet certain eligibility criteria.

Prices can vary depending on the pharmacy you visit and your location.

Learn more: Drugs.com Price Guide

Bottom Line

  • Experts agree that acute migraine treatment should work quickly, have a low incidence of side effects, and be affordable for patients.
  • When possible, most healthcare providers will select nonsteroidal antiinflammatory drugs (NSAIDs) and / or triptans as initial treatment for acute migraine due to proven effectiveness, safety and cost savings.
  • Some patients may not be able to use NSAIDs or triptans due to side effects or health conditions. In these circumstances, newer agents like Ubrelvy, a calcitonin gene-related peptide (CGRP) antagonist, may be an appropriate option.

This is not all the information you need to know about Ubrelvy or triptans for safe and effective use and does not take the place of talking to your doctor about your treatment. Review the full product information here, and discuss this information and any questions you have with your doctor or other health care provider.

References
  • VanderPluym JH, Halker Singh RB, Urtecho M, et al. Acute Treatments for Episodic Migraine in Adults: A Systematic Review and Meta-analysis. JAMA. 2021;325(23):2357–2369. doi:10.1001/jama.2021.7939
  • Edinoff AN, Casey CA, Colon MA, et al. Ubrogepant to Treat Acute Migraine in Adults. Neurol Int. 2021;13(1):32-45. Published 2021 Jan 28. doi:10.3390/neurolint13010004
  • Burch R, Rayhill M. Acute Treatment for Migraine: Contemporary Treatments and Future Directions. JAMA. 2021;325(23):2346–2347. doi:10.1001/jama.2021.7275
  • Robbins MS. Diagnosis and Management of Headache: A Review. JAMA. 2021;325(18):1874–1885. doi:10.1001/jama.2021.1640
  • American Headache Society. The American Headache Society Position Statement On Integrating New Migraine Treatments Into Clinical Practice. Headache. 2019 Jan;59(1):1-18. doi: 10.1111/head.13456. Epub 2018 Dec 10. Erratum in: Headache. 2019 Apr;59(4):650-651.
  • Imitrex (sumatriptan) prescribing information. Revised 12/2020. GlaxoSmithkline. Research Triangle Park, NC 27709. Accessed Oct 12, 2021 at https://gskpro.com/content/dam/global/hcpportal/en_US/Prescribing_Information/Imitrex_Tablets/pdf/IMITREX-TABLETS-PI-PIL.PDF
  • Ubrelvy (ubrogepant) prescribing information. Revised 3/2021. Allergan. Madison, NJ. Accessed Oct. 12, 2021 at https://media.allergan.com/products/Ubrelvy_pi.pdf
  • Dodick DW, Lipton RB, Ailani J, Lu K, Finnegan M, Trugman JM, Szegedi A. Ubrogepant for the Treatment of Migraine. N Engl J Med. 2019 Dec 5;381(23):2230-2241. doi: 10.1056/NEJMoa1813049.

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