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Medically reviewed by Last updated on Sep 2, 2020.


(free ma NEZ ue mab)

Index Terms

  • Fremanezumab-vfrm

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Auto-injector, Subcutaneous:

Ajovy: fremanezumab-vfrm 225 mg/1.5 mL (1.5 mL) [contains disodium edta, polysorbate 80]

Solution Prefilled Syringe, Subcutaneous [preservative free]:

Ajovy: fremanezumab-vfrm 225 mg/1.5 mL (1.5 mL) [contains edetate (edta) disodium dihydrate, polysorbate 80]

Brand Names: U.S.

  • Ajovy

Pharmacologic Category

  • Antimigraine Agent
  • Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonist
  • Monoclonal Antibody, CGRP Antagonist


Fremanezumab is a humanized monoclonal antibody that binds to calcitonin gene-related peptide (CGRP) ligand and blocks its binding to the receptor.


Vd: ~6 L


Degraded by enzymatic proteolysis into small peptides and amino acids


Clearance: 0.141 L/day

Time to Peak

5 to 7 days

Half-Life Elimination

~31 days

Use: Labeled Indications

Migraine prophylaxis: Preventive treatment of migraine in adults


Serious hypersensitivity to fremanezumab or any component of the formulation

Dosing: Adult

Migraine prophylaxis: SubQ: 225 mg monthly or 675 mg every 3 months. When switching dosage options, administer the first dose of the new regimen on the next scheduled date of administration.

Dosing: Geriatric

Refer to adult dosing.


SubQ: For subcutaneous use only. Keep out of direct sunlight and allow prefilled syringe to come to room temperature for 30 minutes before administration. Do not warm by using a heat source (eg, hot water, microwave). Do not shake. Administer in the abdomen, thigh, or upper arm, avoiding areas that are tender, bruised, red, or indurated. The 675 mg dose should be administered as 3 consecutive 225 mg injections. For multiple injections, use the same body site, but not the exact location of the previous injection.


Store at 2°C to 8°C (36°F to 46°F) in the original carton to protect from light. Do not freeze. If necessary, may keep in the original carton at room temperature up to 25°C (77°F) for a maximum of 24 hours. Do not expose to extreme heat or direct sunlight. After removal from the refrigerator, administer within 24 hours or discard.

Drug Interactions

There are no known significant interactions.

Adverse Reactions

>10%: Local: Injection site reaction (43% to 45%)

1% to 10%: Immunologic: Antibody development (≤2%; neutralizing <1%)

Frequency not defined: Hypersensitivity: Hypersensitivity reaction


Concerns related to adverse effects:

• Hypersensitivity: Hypersensitivity reactions, including rash, pruritus, drug hypersensitivity, and urticaria, have been reported. Most reactions were mild to moderate and were reported from within hours to 1 month after administration. If a hypersensitivity reaction occurs, consider discontinuing treatment and institute appropriate therapy.

Disease-related concerns:

• Cardiovascular disease: Patients with a history of significant cardiovascular disease, vascular ischemia, or thrombotic events, such as cerebrovascular accident, transient ischemic attacks, deep vein thrombosis, or pulmonary embolism were excluded from clinical trials; use with caution in these patients.

Dosage form specific issues:

• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade 1986; CDC 1984). See manufacturer's labeling.

Other warnings/precautions:

• Immunogenicity: Anti-fremanezumab antibodies and neutralizing antibodies may develop.

Monitoring Parameters

Number of monthly migraine days.

Reproductive Considerations

Consider the long half-life prior to use in females who may become pregnant until information related to pregnancy is available (Tepper 2018).

Pregnancy Considerations

Adverse events were not observed in animal reproduction studies.

Fremanezumab is a humanized monoclonal antibody (IgG2). Potential placental transfer of human IgG is dependent upon the IgG subclass and gestational age, generally increasing as pregnancy progresses. The lowest exposure would be expected during the period of organogenesis (Palmeira 2012; Pentsuk 2009).

Consider the long half-life prior to use in females who are pregnant until information related to pregnancy is available (Tepper 2018).

Patient Education

What is this drug used for?

• It is used to prevent migraine headaches.

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Severe injection site irritation

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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