Rimegepant
JFDA label: Nurtec
Mechanism of Action
Antagonist of Calcitonin gene-related peptide type 1 receptor — Calcitonin gene-related peptide type 1 receptor antagonist
| Target | Action | Gene / class |
|---|---|---|
| Calcitonin gene-related peptide type 1 receptor efficacy | ANTAGONIST | CALCRL |
Indications
Off-label
- Irritable Bowel Syndrome
- Migraine Disorders
- Pain
- Psoriasis
- Sinusitis
- Temporomandibular Joint Disorders
- Trigeminal Neuralgia
Contraindications
Source: openFDA
- is contraindicated in patients with a history of hypersensitivity reaction to rimegepant, NURTEC ODT, or any of its components. Reactions have included anaphylaxis and delayed serious hypersensitivity [see Warnings and Precautions (5.1) ] . Patients with a history of hypersensitivity reaction to rimegepant, NURTEC ODT, or to any of its components. ( 4 ) Absolute
Dosing
Source: openFDA
Warnings & Precautions
Source: openFDA
Warnings & Precautions
• Hypersensitivity Reactions: If a serious hypersensitivity reaction occurs, discontinue NURTEC ODT and initiate appropriate therapy. Severe hypersensitivity reactions have included anaphylaxis, dyspnea, and rash, and can occur days after administration. ( 5.1 ) • Hypertension: New-onset or worsening of pre-existing hypertension may occur. ( 5.2 ) • Raynaud’s Phenomenon: New-onset or worsening of pre-existing Raynaud’s phenomenon may occur. ( 5.3 )
Hypersensitivity Reactions Serious hypersensitivity reactions, includi
Hypersensitivity Reactions Serious hypersensitivity reactions, including anaphylaxis, dyspnea , and rash, have occurred in patients treated with NURTEC ODT . Hypersensitivity reactions can occur days after administration, and delayed serious hypersensitivity has occurred. If a hypersensitivity reaction occurs, discontinue NURTEC ODT and initiate appropriate therapy [see Contraindications (4) and Adverse Reactions (6.1 , 6.2) ] .
Hypertension Development of hypertension and worsening of pre-existing
Hypertension Development of hypertension and worsening of pre-existing hypertension have been reported following the use of CGRP antagonists, including NURTEC ODT, in the postmarketing setting. Some of the patients who developed new-onset hypertension had risk factors for hypertension. There were cases requiring initiation of pharmacological treatment for hypertension and, in some cases, hospitalization. Hypertension may occur at any time during treatment, but was most frequently reported within 7 days of therapy initiation. NURTEC ODT was discontinued in many of the reported cases. Monitor patients treated with NURTEC ODT for new-onset hypertension or worsening of pre-existing hypertension, and consider whether discontinuation of NURTEC ODT is warranted if evaluation fails to establish an alternative etiology or blood pressure is inadequately controlled.
Raynaud’s Phenomenon Development of Raynaud’s phenomenon and recurrenc
Raynaud’s Phenomenon Development of Raynaud’s phenomenon and recurrence or worsening of pre-existing Raynaud’s phenomenon have been reported in the postmarketing setting following the use of CGRP antagonists, including NURTEC ODT. In reported cases with small molecule CGRP antagonists, symptom onset occurred a median of 1.5 days following dosing. Many of the cases reported serious outcomes, including hospitalizations and disability, generally related to debilitating pain. In most reported cases, discontinuation of the CGRP antagonist resulted in resolution of symptoms. NURTEC ODT should be discontinued if signs or symptoms of Raynaud’s phenomenon develop, and patients should be evaluated by a healthcare provider if symptoms do not resolve. Patients with a history of Raynaud’s phenomenon should be monitored for, and informed about the possibility of, worsening or recurrence of signs and symptoms.
Pregnancy & Lactation
Lactation
However, amounts in breastmilk are low and would not be expected to cause any adverse
Chemistry & Properties
| Formula | C28H28F2N6O3 |
|---|---|
| Molecular weight | 534.57 g/mol |
| IUPAC name | [(5S,6S,9R)-5-amino-6-(2,3-difluorophenyl)-6,7,8,9-tetrahydro-5H-cyclohepta[b]pyridin-9-yl] 4-(2-oxo-3H-imidazo[4,5-b]pyridin-1-yl)piperidine-1-carboxylate |
| CAS | 1289023-67-1 |
| PubChem CID | 51049968 |
| InChIKey | KRNAOFGYEFKHPB-ANJVHQHFSA-N |
| logP | 4.49 (XLogP 2.3) |
| Polar surface area | 119.13 Ų |
| H-bond acceptors / donors | 7 / 2 |
| Drug-likeness (QED) | 0.37 |
| Lipinski violations | 1 |
SMILES
N[C@@H]1c2cccnc2[C@H](OC(=O)N2CCC(n3c(=O)[nH]c4ncccc43)CC2)CC[C@H]1c1cccc(F)c1FBiology & Pharmacokinetics
Pharmacokinetics predicted
| Bioavailability | 70.0% |
|---|---|
| Half-life | 0.689 h |
| Volume of distribution | 1.326 L/kg |
| Protein binding | 90.2% |
| BBB penetrant | No |
Enzyme interactions
| Enzyme | Role | Detail |
|---|---|---|
| CYP2C8 | Inhibitor | — |
| CYP3A4 | Inhibitor | IC₅₀ 17.000000000000007 µM |
Receptor binding (top 2)
| Target | Action | Affinity |
|---|---|---|
| CGRP receptor (CALCRL|RAMP1) | Antagonist | pKB 9.6 |
| AMY1 receptor (CALCR|RAMP1) | Antagonist | pKB 8.1 |
Transporters
BCRP (Inhibitor)BSEP (Inhibitor)MATE1 (Inhibitor)MRP1 (Inhibitor)OATP1B1 (Inhibitor)OATP1B3 (Inhibitor)OATP1B3 (Inhibitor)P-gp (Inhibitor)BCRP (Substrate)MDR1 (Substrate)P-gp (Substrate)
Drug–drug interactions (55, DDInter)
| Interacting drug | Severity | Management |
|---|---|---|
| Apalutamide | major | |
| Dabrafenib | major | |
| Dexamethasone | major | |
| Enzalutamide | major | |
| Lorlatinib | major | |
| Lumacaftor | major | |
| Mitotane | major | |
| Abiraterone | moderate | |
| Afatinib | moderate | |
| Alpelisib | moderate | |
| Aprepitant | moderate | |
| Ceritinib | moderate | |
| Chloramphenicol | moderate | |
| Clarithromycin | moderate | |
| Cobicistat | moderate | |
| Cobimetinib | moderate | |
| Crizotinib | moderate | |
| Cyclosporine | moderate | |
| Darolutamide | moderate | |
| Eltrombopag | moderate | |
| Enasidenib | moderate | |
| Encorafenib | moderate | |
| Entrectinib | moderate | |
| Erythromycin | moderate | |
| Fedratinib | moderate | |
| Fluconazole | moderate | |
| Gefitinib | moderate | |
| Gilteritinib | moderate | |
| Glasdegib | moderate | |
| Ibrutinib | moderate | |
| Idelalisib | moderate | |
| Imatinib | moderate | |
| Ivacaftor | moderate | |
| Ketoconazole | moderate | |
| Lapatinib | moderate | |
| Larotrectinib | moderate | |
| Midostaurin | moderate | |
| Neratinib | moderate | |
| Niraparib | moderate | |
| Olaparib | moderate |
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Registered Products (1)
| Brand | Form / strength | Pack | Agent | Citizen (JOD) |
|---|---|---|---|---|
| Nurtec | Tablet 75 mg | 8 tab | Khoury Drug Store | 147.680 |