Rimegepant (Vydura ™) is indicated for adults who have at least 4 migraine attacks per month but less than 15. It is taken as a wafer which dissolves under the tongue. It works by stopping the release of a protein around the brain that is responsible for the severe pain associated with migraine attacks.
It is recommended as an option for preventing episodic migraine in adults where at least 3 previous preventive treatments have failed (NICE May 2023)
In a study by Baker et al (2022) 12 breastfeeding mothers aged 18-40 years provided plasma and breastmilk samples over a 36 hour period.
It is highly protein bound 96%, with an oral bioavailability 64%, and milk plasma ratio 0.2. On a weight-adjusted basis, infants received an estimated dose that was approximately 0.51% of the maternal dose (Hale).
References
- Baker TE, Croop R, Kamen L, Price P, Stock DA, Ivans A, Bhardwaj R, Anderson MS, Madonia J, Stringfellow J, Bertz R, Coric V, Hale TW. Human Milk and Plasma Pharmacokinetics of Single-Dose Rimegepant 75 mg in Healthy Lactating Women. Breastfeed Med. 2022 Mar;17(3):277-282
- Rimegepant for preventing migraine NICE TA 906 July 2023 https://www.nice.org.uk/guidance/TA906/history
- Hale TW and Kruscher K Medications and Mothers milk 2023 (online access September 2023)
- E lactancia ( online access September 2023)
- Lactmed https://www.ncbi.nlm.nih.gov/books/NBK563395/ accessed September 2023
