atogepant

Contraindicated in:

Hypersensitivity;
Severe renal impairment or end-stage renal disease (for chronic migraine prevention);
Severe hepatic impairment.

Use Cautiously in:

Hypertension;
Raynaud phenomenon;
Severe renal impairment or end-stage renal disease (for episodic migraine prevention);
OB: Oral CGRP antagonists not currently recommended for prevention of migraine during pregnancy;
Lactation: Oral CGRP antagonists not currently recommended for prevention of migraine while breastfeeding;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypertension, Raynaud phenomenon

GI: constipation, nausea

Metab: ↓appetite, weight loss

Neuro: dizziness, fatigue, sedation

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

Strong CYP3A4 inhibitors, including itraconazole, may ↑ levels and risk of toxicity; ↓ dose.
Strong CYP3A4 inducers, including rifampin; moderate CYP3A4 inducers; or weak CYP3A4 inducers, including topiramate, may ↓ levels and effectiveness; ↑ atogepant dose for episodic migraine prevention; avoid concurrent use for chronic migraine prevention.
OATP inhibitors, including rifampin, may ↑ levels and risk of toxicity; ↓ atogepant dose for episodic or chronic migraine prevention.

Natural-Natural Products:

St. John's wort may ↓ levels and effectiveness; avoid concurrent use.

Drug-Food:

Grapefruit juice may ↑ levels and risk of toxicity; avoid concurrent use.

Availability ⬆ ⬇

Tablets: 10 mg; 30 mg; 60 mg

Route/Dosage ⬆ ⬇

Episodic Migraine

PO (Adults ): 10 mg, 30 mg, or 60 mg once daily. Concurrent use of strong CYP3A4 inhibitors: 10 mg once daily. Concurrent use of strong, moderate, or weak CYP3A4 inducers: 30 mg or 60 mg once daily. Concurrent use of OATP inhibitors: 10 mg or 30 mg once daily.

Renal Impairment

PO (Adults ): CCr <30 mL/min: 10 mg once daily.

Chronic Migraine

PO (Adults ): 60 mg once daily. Concurrent use of strong CYP3A4 inhibitors: 10 mg once daily. Concurrent use of strong, moderate, or weak CYP3A4 inducers: Avoid concurrent use. Concurrent use of OATP inhibitors: 30 mg once daily.

Renal Impairment

PO (Adults ): CCr <30 mL/min: Avoid use.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Binds to and inhibits the calcitonin gene-related peptide (CGRP) receptor, which reduces the neuroinflammatory and vasodilatory effects of CGRP.

Therapeutic effects:

Reduction in number of monthly migraine days.

Classifications ⬆ ⬇

Therapeutic Classification: vascular headache suppressants

Pharmacologic Classification: calcitonin gene-related peptide receptor antagonists

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed following oral administration.

Distribution: Well distributed to tissues.

Metabolism/Excretion: Primarily metabolized in the liver via the CYP3A4 isoenzyme. Primarily excreted as unchanged drug in feces (42%) and urine (5%).

Half-Life: 11 hr.

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	rapid	1–2 hr	unknown

Patient/Family Teaching ⬆ ⬇

Explain the purpose and side effects of atogepant. Instruct patient to take as directed. Advise patient to read Patient Information before starting and with each Rx refill in case of changes.
Advise patient that use of triptans, ergotamine derivatives, NSAIDs, acetaminophen, and opioids for headache treatment while taking atogepant is acceptable.
Advise patient to avoid alcohol, which aggravates headaches, during atogepant use.
Advise patient that lying down in a darkened room following atogepant administration may further help relieve headache.
Inform patients of potential for hypersensitivity reaction and that these reactions can occur days after administration of atogepant. Advise patients to call 911 and immediately seek treatment for signs and symptoms of hypersensitivity reactions (difficulty breathing; chest tightness; hives; rash; light-headedness; itching; swelling of the face, lips, tongue, or throat). If hypersensitivity reaction occurs, discontinue atogepant.
Advise patient to avoid grapefruit juice during therapy.
Advise patient to report symptoms of ↑ BP or worsening pre-existing HTN.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications. Avoid St. John's wort during treatment.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding. Inform patient of the pregnancy exposure registry that monitors pregnancy outcomes in women exposed to Qulipta. For more information, health care providers or patients are encouraged to contact: 1-833-277-0206 or visit http://empresspregnancyregistry.com.

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Indications ⬇

Contraind./Precautions ⬆ ⬇