Acute Migraine Relief Meds: Rimegepant (Nurtec^® ODT) vs. Sumatriptan (Imitrex^®)

Migraines, severe headaches with accompanying symptoms like nausea, sensitivity to light and sound, are a common and debilitating neurological condition affecting millions worldwide. Acute migraine medications offer relief when a migraine hits.

Two prominent acute migraine relief medications are rimegepant (Nurtec ODT) and sumatriptan (Imitrex). To help you make decisions about your acute migraine care, outlined below is detailed information on the mechanisms, side effects, effectiveness, costs and potential interactions of rimegepant and sumatriptan.

What is rimegepant (Nurtec ODT)?

Rimegepant (Nurtec ODT) belongs to a class of medications called oral calcitonin gene-related peptide (CGRP) antagonists, commonly known as oral gepants. It is approved as an acute migraine treatment.¹

At the beginning of a migraine cycle, CGRP is released by the nerves and can prolong the migraine episode. Oral gepants bind to receptors to block the release of CGRP, resulting in a shortened migraine.²

It can take one to two hours to experience migraine symptom relief after taking rimegepant.³ The effects of rimegepant last for about one day after ingestion. The recommended dosing for rimegepant is one 75 mg tablet once daily. No more than one tablet should be taken within a 24-hour period.⁴

What is sumatriptan (Imitrex)?

Sumatriptan (Imitrex) belongs to the class of medications known as selective serotonin receptor agonists. It works to treat migraines by narrowing blood vessels in the head, blocking pain signals in the brain, and inhibiting the release of naturally occurring chemical transmitters that can cause nausea, pain and other migraine symptoms. Sumatriptan is only used to treat migraines in the short term and will not prevent or reduce future migraines.⁵

Oral tablet dosages for sumatriptan include 25 mg, 50 mg or 100 mg taken just once. If migraine symptoms persist or return after two hours, another dose can be taken. However, the max dosage recommended is 200 mg in a 24-hour period.⁶

What’s the difference between Nurtec ODT and sumatriptan?

Both Nurtec ODT and sumatriptan are used as acute treatments of migraines, but they have different mechanisms of action. The ODT in Nurtec’s name stands for oral disintegrating tablet and is used by placing it under the tongue to dissolve. Nurtec ODT has less reported side effects than sumatriptan; however, both can cause nausea and stomach upset.⁷

Sumatriptan starts taking effect within 10 to 20 minutes after ingestion.⁸ Nurtec ODT is slower acting and can take up to two hours to take full effect.⁹ The maximum recommended dose is one 75 mg tablet of Nurtec ODT in 24 hours.¹⁰ With sumatriptan, if you do not feel relief within two hours after the first dose, another dose can be taken, with a maximum of 200 mg in a 24-hour period.¹¹

How effective are Nurtec ODT and sumatriptan for treating acute migraine attacks?

In a clinical trial of Nurtec ODT, participants took 75 mg as an acute treatment of migraine. Approximately 22% were completely pain-free two hours after the dose of Nurtec ODT.

Approximately 35% were free from their most bothersome migraine symptom.¹² Most people who take Nurtec ODT do experience some relief within the first two hours after ingestion.¹³

In a study of sumatriptan, 65% to 78% reported relief from migraine pain four hours after taking the medicine. Participants also reported oral sumatriptan relieved nausea and photophobia (sensitivity to light).¹⁴ Sumatriptan is available in three forms: oral tablet, injection and nasal spray. The tablet will work around 10 to 20 minutes after ingestion, while injection and nasal spray are closer to five minutes for results. The peak effect occurs within two to four hours.¹⁵

Can Nurtec ODT and sumatriptan be used together?

There are no known negative interactions between Nurtec ODT and sumatriptan. Always consult with your health care provider before combining medications.¹⁶

How often can Nurtec ODT and sumatriptan be taken?

Both Nurtec ODT and sumatriptan are designed for single, acute treatment of migraines. They can be taken on an as needed basis when migraine symptoms start.

Nurtec ODT should only be taken once per day with a maximum of 75 mg in a 24-hour period.¹⁷

Sumatriptan is recommended to be taken once daily; however, a second dose can be taken two hours after the first dose if symptoms persist or return. The recommended maximum dosage of sumatriptan is 200 mg in a 24-hour period.¹⁸

How do the side effects compare for Nurtec ODT and sumatriptan?

The side effects of Nurtec ODT and sumatriptan do vary. Sumatriptan has more reported side effects than Nurtec ODT.

Side effects of Nurtec ODT include:¹⁹

• Nausea.

• Abdominal pain.

• Rash (rare).

Side effects of sumatriptan include:²⁰

• Dizziness.

• Nausea.

• Flushing.

• Drowsiness.

• Muscle cramps.

• Upset stomach.

• Vomiting.

• Diarrhea.

• Tingling.

• Weakness.

What are common interactions between Nurtec ODT and sumatriptan?

There are no known negative interactions between Nurtec ODT and sumatriptan. However, each medication does have interactions with other medications and food.²¹

Gepants, like Nurtec ODT, should NOT be taken with the following medications:²²

• Ubrogepant (Ubrelvy^®)

• DHE (Migranal^®)

• Almotriptan (Axert^®)

• Eletriptan (Relpax^®)

• Ketoconazole

• Itraconazole

• Clarithromycin

• Cyclosporine

• Ciprofloxacin

• Fluconazole

• Fluvoxamine

• Rifampin

• Phenytoin

• Barbiturates

Users of Nurtec ODT should also avoid these foods and supplements:

• Grapefruit (including grapefruit juice).

• Pomegranate.

• Starfruit.

• Turmeric.

• Licorice.

• Feverfew.

• Evening primrose.

• Dong Quai.

• Echinacea.

• Goldenseal.

• Curcumin.

• St. John’s Wart.

Sumatriptan should NOT be taken with the following medications:²³

• Dihydroergotamine (Migranal^®, Trudhesa^®).

• Ergotamine (Cafergot^®, Ergomar^®, Ergostat^®).

How do costs compare for Nurtec ODT and sumatriptan?

Nurtec ODT does not come in a lower-cost generic but sumatriptan does. This makes sumatriptan significantly less expensive than Nurtec ODT. The average cost per dose of Nurtec ODT is $126. Sumatriptan’s average cost per dose ranges from $45 to $55 per dose.²⁴ However, with RedBox Rx, sumatriptan is as low as $35 for nine tablets (9 tablets).

Rimegepant (Nurtec ODT) vs. Sumatriptan (Imitrex) Comparison Chart

How RedBox Rx can help

RedBox Rx makes receiving acute treatment for headaches and migraines easy and affordable.

Benefits of RedBox Rx include:

• Transparent, affordable flat rates for medications, with sumatriptan starting at $35 per treatment (nine tablets).

• $20 online consultation with a U.S. licensed medical professional.

• No insurance required. FSA and HSA eligible.

• No office wait times or scheduling issues typical with physical medical practices.

• FREE shipping directly to you. Monthly and quarterly subscriptions available.

Get started on your migraine treatment journey with an online assessment.