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Aimovig: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on Nov 25, 2020.

1. How it works

  • Aimovig is a brand (trade) name for erenumab (also called erenumab-aooe) which is a biologic monoclonal antibody that may be used to prevent migraine headaches in adults.
  • Erenumab works by blocking the effect of a protein, called CGRP (calcitonin gene-related peptide) which is involved in pain transmission, inflammation, and blood vessel dilation and is found in the sensory nerves of the head and neck. Erenumab binds to the CGRP receptor and prevents it from interacting with CGRP. This helps to prevent the development of a migraine headache and associated pain.
  • Aimovig belongs to the class of medicines known as CGRP inhibitors. There are two types of CGRP inhibitors – monoclonal antibodies and CGRP receptor antagonists (gepants). Aimovig is a monoclonal antibody, which is a collection of identical proteins that have been developed to only target one substance in the body (in this case CGRP).

2. Upsides

  • May be used to prevent migraine headaches in adults.
  • Aimovig was the first CGRP inhibitor to be approved (May 2018).
  • Aimovig is long-acting and only needs to be given once a month by subcutaneous (under the skin) injection into the stomach (abdomen) area, upper arm, or thigh. Aimovig is easy to self-administer.
  • The usual dose is 70mg once monthly; however, some patients may benefit from 140mg once monthly.
  • Available as a single-dose prefilled autoinjector or syringe. Both formulations have a 70mg/mL strength and a 140 mg/mL strength.
  • Research has not shown Aimovig to affect the immune system or lower immunity nor to cause hair loss.
  • Monoclonal antibodies, such as Aimovig, tend to have few drug interactions and are unlikely to cause liver or kidney damage.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Injection site reactions (pain, redness, or swelling) and constipation are the most common side effects reported with Aimovig.
  • Constipation is caused by Aimovig blocking intestinal CGRP and in some people, this may be severe and lead to hospitalization or the need for surgery. Constipation was reported in up to 3% of people receiving Aimovig 140mg in clinical trials (reported in 1% with the 70mg dose).
  • Aimovig may also cause serious allergies, cramps, or muscle spasms. There have been reports of people developing high blood pressure or a worsening of their high blood pressure, most frequently within 7 days of administration. Many already had pre-existing hypertension or risk factors for hypertension. Some required treatment and hospitalization.
  • Elderly patients over the age of 65 years should be dosed at the low end of the dosage range because of the greater risk for liver, kidney, or heart disease, other medical conditions, or drug interactions.
  • Should not be given to people with serious hypersensitivity to erenumab-aooe or any of the excipients.
  • It is not known if Aimovig will harm an unborn baby or pass into breast milk.

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Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Aimovig is a prescription medicine that can be self-injected under the skin once a month to prevent migraine headaches in adults. Injection site reactions and constipation are the most common side effects but it has no reported drug interactions.

5. Tips

  • Aimovig is injected under the skin once a month into your stomach area (abdomen), thigh, or upper arm and you can learn to give yourself injections at home.
  • Aimovig is available as an autoinjector or prefilled syringe. An autoinjector is a device that typically contains one prefilled dose of medicine in a spring-loaded syringe. You, or your caregiver, can learn to give this medicine at home. Many patients prefer autoinjectors over single-use syringes as they are easier to use and may cause less worry.
  • Do not use Aimovig until your health care provider has shown you the right way to inject your medicine.Do not use an Aimovig autoinjector or prefilled syringe injection if the solution inside looks cloudy, has changed colors, or has particles in it. Do not shake the autoinjector or syringe.
  • Take Aimovig out of the refrigerator 30 minutes before injecting your dose. Do not heat in water or the microwave. Wash your hands with soap and water before you give the injection. Choose an injection site, for example, your stomach area (at least 2 inches away from your belly button), your thigh, or your upper arm (if someone else is injecting). Use an alcohol wipe to clean the area you plan to inject and let it dry. Do not inject Aimovig into an area that is tender, bruised, hard, or red.
  • To use the Aimovig autoinjector: Pull the cap off of the autoinjector no more than 5 minutes before you use it. Pinch or stretch the area of skin where you are going to inject. Place the autoinjector on your skin area at about a 90-degree angle (straight up and down). Keep your skin stretched or pinched while injecting. Firmly push the autoinjector down onto the skin until the autoinjector stops moving. When you are ready to inject, push the start button on the top of the autoinjector. You will hear a click. Keep pushing down on your skin. Then lift your thumb while still holding the autoinjector on your skin. Your injection could take about 15 seconds. After you remove the autoinjector from your skin, the needle will be automatically covered. Once you have used the dose, place the autoinjector or syringe in a puncture-proof "sharps" container. Follow state or local laws about how to dispose of this container. Sharps containers can be purchased online or at retail shops. Keep Aimovig out of the reach of children and pets.
  • If the site is bleeding, press a cotton ball or gauze firmly on the skin. Apply an adhesive bandage (“Band-Aid”) if needed.
  • When you remove the autoinjector, if the window is not yellow or if it seems like the medicine is still injecting, you may not have received a full dose. Call your health care provider immediately.
  • Aimovig should be stored in the refrigerator at 2°C to 8°C (36°F to 46°F) in the original carton to protect from light until time of use. If removed from the refrigerator, Aimovig can be kept at room temperature (up to 25°C [77°F]) in the original carton and must be used within 7 days. Throw away Aimovig that has been left at room temperature for more than 7 days. Do not freeze. Do not shake. Do not put the autoinjector back in the refrigerator after it has reached room temperature.
  • If you have an allergy to latex or rubber you may not be able to use Aimovog. The Aimovig injections devices contain a dry natural rubber (a derivative of latex), which may cause allergic reactions in some people sensitive to latex. Do not use Aimovig if you are allergic to it or any other inactive ingredients, which include acetate, polysorbate 80, and sucrose.
  • If you miss a dose of Aimovig, administer it as soon as possible. Do not double your dose to make up for missed dose. Thereafter, your Aimovig dose can be scheduled monthly from the date of your last dose. If you have questions about your dose or when to administer it, call your doctor.
  • Although there is not a specific warning against consuming alcohol with Aimovig, alcohol may trigger or worsen a migraine headache in many people, especially red wine, beer, and hard liquor. Limit your alcohol intake or avoid alcohol.
  • Be aware of other foods or substances that can worsen migraines, such as excessive caffeine, some aged cheeses or processed foods (especially those that contain tyramine), food additives such as the artificial sweetener aspartame, preservatives like sulfites, and the flavor enhancer monosodium glutamate (MSG). Aimovig is an injectable migraine medicine in the class of drugs known as CGRP inhibitors. Aimovig is used monthly for migraine prevention.
  • Aimovig may cause constipation, which can be severe in some patients. Most people who develop constipation with Aimovig do so after the first injection, but it can occur later. Your doctor should monitor you for constipation and manage it as needed. If you develop constipation while taking Aimovig, contact your doctor for management. Do not stop taking your medicine without first talking to your doctor. Using other medications that can cause constipation may increase your risk for more severe constipation and constipation-related complications. Discuss this with your doctor.
  • Call your health care provider or get emergency medical help right away if you experience swelling of the face, mouth, tongue, or throat or have trouble breathing. These are all signs of a possible allergic reaction.
  • Aimovig may also worsen blood pressure or cause high blood pressure. Your doctor should monitor you for the development of this.
  • If you are pregnant or intend to become pregnant, tell your doctor as it is not known if Aimovig will harm an unborn baby. Also, talk to your doctor about breastfeeding your baby while you are self-administering Aimovig.

6. Response and Effectiveness

  • Aimovig is given by injection subcutaneously (under the skin), to avoid degradation by the stomach. Because it is a large molecule, it takes longer to start working, and works in the lining of the brain rather than in the brain itself.
  • Aimovig has been studied for the prevention of episodic (4-14 migraine days per month) and chronic migraine (15 or more migraine days per month) headaches.
  • In a 6-month study of patients with episodic migraine, patients who received Aimovig had an average of 3 to 4 fewer migraine days compared to about 2 fewer migraine days per month for those taking an inactive placebo.
  • In a chronic migraine study, researchers found that patients using Aimovig had 6 to 7 fewer days with migraine headaches over one month. This compared to 4 fewer migraine days with those taking an inactive placebo.
  • In addition, many patients taking Aimovig were able to reduce their monthly migraine days by 50% or more, compared to 24% (chronic migraine group) to 27% (episodic migraine group) of those taking the placebo.
  • It takes approximately 154 days (22 weeks, or over 5 months) for Aimovig to be eliminated from your system.

7. Interactions

There are currently no documented interactions with Aimovig, according to the product information.

Aimovig is not metabolized by cytochrome P450 enzymes; therefore, interactions with concomitant medications that are substrates, inducers, or inhibitors of cytochrome P450 enzymes are unlikely.

You should refer to the prescribing information for Aimovig for any updates or newly noted interactions.

References

Aimovig (erenumab-aooe) [Package insert] Updated 04/2020. Amgen Inc. https://www.drugs.com/pro/aimovig.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Aimovig only for the indication prescribed.

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