Abstract
In the last few years, there have been significant advances in migraine management and prevention. Lasmiditan, ubrogepant, rimegepant and monoclonal antibodies (erenumab, fremanezumab, galcanezumab, and eptinezumab) are new drugs that were launched on the US pharmaceutical market; some of them also in Europe. This publication reviews the available worldwide references on the safety of these anti-migraine drugs with a focus on the possible drug–drug (DDI) or drug–food interactions. As is known, bioavailability of a drug and, hence, its pharmacological efficacy depend on its pharmacokinetics and pharmacodynamics, which may be altered by drug interactions. This paper discusses the interactions of gepants and lasmiditan with, i.a., serotonergic drugs, CYP3A4 inhibitors, and inducers or breast cancer resistant protein (BCRP) and P-glycoprotein (P-gp) inhibitors. In the case of monoclonal antibodies, the issue of pharmacodynamic interactions related to the modulation of the immune system functions was addressed. It also focuses on the effect of monoclonal antibodies on expression of class Fc gamma receptors (FcγR).
Highlights
Migraine is a chronic neurological disorder characterized by a repetitive, usually unilateral, pulsating headache with attacks typically lasting from 4 to 72 h
This review presents information on safety and possible pharmacokinetic and pharmacodynamics interactions of the newest drugs used to stop migraine attacks, i.e., lasmiditan, ubrogepant, and rimegepant, as well as anti-CGRP monoclonal antibodies administered to prevent migraine
Lasmiditan exhibited in vitro inhibition of intestinal P-gp and breast cancer resistant protein (BCRP) with drug–drug interaction indices Igut/IC50 of 25 and 16, respectively [42]
Summary
Migraine is a chronic neurological disorder characterized by a repetitive, usually unilateral, pulsating headache with attacks typically lasting from 4 to 72 h. In moderate to severe attacks, usually triptans alone or in combination therapy with non-steroidal anti-inflammatory drugs (NSAIDs) or paracetamol and antiemetics are recommended. Due to their vasoconstriction effect, triptans are contraindicated in patients with ischemic heart disease or peripheral vascular disease. If two drugs are used simultaneously, there is already a clinically significant risk of interaction; if there are more than seven drugs, interaction is relatively certain [19] This is of particular importance in the context of the ever-increasing number of chronically ill patients and aging population. This review presents information on safety and possible pharmacokinetic and pharmacodynamics interactions of the newest drugs used to stop migraine attacks, i.e., lasmiditan, ubrogepant, and rimegepant, as well as anti-CGRP monoclonal antibodies administered to prevent migraine
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