Atogepant

Class
Antimigraine agents
Subclass
CGRP receptor antagonists
Substance name
Atogepant
Brand names
Qulipta®
Common formulations
Tablet
Dosage and administration
Adults patients
Migraine attacks • Episodic
•
Start at: 10 mg PO daily
•
Maintenance: 10-60 mg PO daily
Migraine attacks • Chronic
•
60 mg PO daily
Indications for use
Labeled indications
Adults
•
Prevention of migraine attacks (chronic)
•
Prevention of migraine attacks (episodic)
Safety risks
Contraindications
Hypersensitivity to atogepant or its components
Warnings and precautions
Decreased serum rimegepant levels
•
Use caution in patients taking CYP3A4 inducers. Increase atogepant dose to 30-60 mg once daily for episodic migraine. Avoid use for chronic migraine.
Drug hypersensitivity reaction
•
Maintain a high level of suspicion, as atogepant has been associated with an increased risk of hypersensitivity reactions, including anaphylaxis, dyspnea, skin rash, pruritus, urticaria, and facial edema.
Increased serum rimegepant levels
•
Use caution in patients taking strong CYP3A4 inhibitors. Reduce atogepant dose to 10 mg once daily for episodic migraine. Avoid use for chronic migraine.
•
Use caution OATP inhibitors. Reduce atogepant dose to 10-30 mg once daily for episodic migraine and 30 mg once daily for chronic migraine.
Specific populations
Renal impairment
CrCl ≥ 30 mL/min
•
Use acceptable. No dose adjustment required.
CrCl < 30 mL/min
•
Reduce to 10 mg once daily for episodic migraine. Avoid use for chronic migraine.
Hepatic impairment
Child-Pugh A (mild)
•
Use acceptable. No dose adjustment required.
Child-Pugh B (moderate)
•
Use acceptable. No dose adjustment required.
Child-Pugh C (severe)
•
Avoid use.
Pregnancy and breastfeeding
Pregnancy
All trimesters
•
Insufficient evidence. Avoid use. Evidence of fetal harm in animals. Use nonpharmacological measures as the first-line approach for migraine prophylaxis in pregnancy. Offer CCBs and antihistamines as safe options for the prevention of primary headaches in pregnancy. Consider offering β-blockers as a second-line option while balancing the benefits and risks.
Breastfeeding
Little information available on breastfeeding safety.
•
Consider alternative agents that may be safer. Avoid using pharmacological prophylaxis for migraine during lactation.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Common 1-10%
•
Constipation, dizziness, fatigue, somnolence, loss of appetite, nausea, weight loss
Uncommon < 1%
•
↑ serum transaminases
Unknown frequency
•
Anaphylaxis, skin rash, itching, dyspnea, facial edema, urticaria
Interactions
Drug(s)
Check Interactions
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