Stay Up to Date on “New” Migraine Meds

You’ll hear buzz about three “new” meds for acute migraine relief.

They’re just new versions of old meds...but be aware of differences.

Dihydroergotamine (DHE). Atzumi nasal powder and Brekiya subcutaneous auto-injector will join the nasal spray and IV forms of DHE that have been available for years.

Watch for instructions to “Use as directed.” Directions will need to be clarified to avoid patient confusion...and billing mishaps.

Ensure patients receive pharmacist counseling on proper use.

For example, patients should pump the Atzumi device 3 times in the SAME nostril while inhaling to get the 5.2 mg dose...and NOT prime it before use. The dose can be repeated once after at least an hour.

And patients need to inject Brekiya into the mid-thigh...to deliver the 1 mg dose...and may repeat at 1 hr intervals (max of 3 mg in 24 hrs).

Update patient profiles with medical conditions, pregnancy status, smoking status, etc...to help keep patients getting DHE products safe.

DHE carries risks for serious adverse effects (stroke, etc)...and is contraindicated in pregnancy or patients with uncontrolled hypertension, heart disease, and several other cardiovascular conditions.

Alert the pharmacist if the patient is also taking a triptan (sumatriptan, etc). DHE should not be taken within 24 hours of a triptan because of the increased risk of serious cardiovascular adverse effects.

Anticipate that these new DHE forms will be expensive...and require prior authorization. Plus DHE is typically saved for patients not responding to first-line treatments, such as triptans.

NSAID/triptan. Symbravo is oral meloxicam 20 mg/rizatriptan 10 mg. It joins naproxen 500 mg/sumatriptan 85 mg (Treximet)...the only other NSAID/triptan combo tab.

Patients will take one meloxicam/rizatriptan tablet by mouth as needed for acute migraine (max of 1 tablet/24 hr).

Watch days’ supply and notify the pharmacist if insurance rejects or requires a prior auth. Symbravo comes in a bottle of 9 tablets, typically billed for a 30-day supply...and costs about $1,100.

The pharmacist may recommend lower-cost options, such as taking these 2 meds individually. For example, 9 tablets of meloxicam 15 mg is about $30 and 9 tablets of rizatriptan 10 mg is about $4.

Review other meds with our resource, Drugs for Acute Migraine.

• Chart: Drugs for Acute Migraine