Nurtec ODT (rimegepant) is a 75 mg tablet taken as needed for acute migraine attacks or every other day for migraine prevention. The dosing schedule depends entirely on which purpose you’re using it for, and the rules are different for each.
Dosing for Acute Migraine Attacks
When you take Nurtec to treat a migraine that’s already started, the dose is one 75 mg tablet. You should not take more than one tablet in a 24-hour period. There is no second dose if the first one doesn’t fully relieve your symptoms. This is different from some other migraine medications that allow a repeat dose after a set window.
The tablet dissolves on your tongue without water, and the medication reaches its peak concentration in about 1.5 hours. Many people notice relief within an hour. In clinical trials, about 21% of patients were completely pain-free at the two-hour mark (compared to 11% on placebo), and 35% had their most bothersome symptom eliminated.
Dosing for Migraine Prevention
For preventive use, Nurtec follows a fixed schedule: one 75 mg tablet every other day. You take it whether or not you have a migraine that day. This works out to roughly 15 tablets per month.
If you miss a preventive dose, take it as soon as you remember. But if it’s already close to your next scheduled dose, skip the missed one and resume your regular every-other-day pattern. Don’t double up to make up for a missed dose.
Using Nurtec for Both Purposes
Nurtec is the only migraine medication FDA-approved for both acute treatment and prevention. If your doctor prescribes it for prevention, you’re already taking it every other day. On a day you don’t have a scheduled preventive dose, you can take a tablet to treat a migraine that comes on. The key rule remains the same: no more than one 75 mg tablet in any 24-hour period.
Lower Risk of Rebound Headaches
One concern with frequent use of migraine medications is medication overuse headache, sometimes called rebound headache. Triptans and common painkillers are well-known triggers for this problem, which affects up to 2% of the general population. Nurtec appears to carry a much lower risk. A real-world study of nearly 120,000 patients found that switching to Nurtec from triptans reduced the prevalence of medication overuse headache by 70% within three months. That reduction held steady through nine months of follow-up. This is one reason the every-other-day preventive schedule is considered relatively safe for ongoing use.
Food and Timing
You can take Nurtec with or without food. That said, eating does slow absorption. A high-fat meal delays the peak by about 1 to 1.5 hours and reduces how much of the drug your body absorbs by roughly a third. For preventive dosing, this likely doesn’t matter much since you’re building consistent levels over time. For acute treatment, taking it on an empty stomach may get you faster relief.
Drug Interactions That Change the Schedule
Certain medications interfere with how your body processes Nurtec, and this can change how often you can safely take it.
- Moderate CYP3A4 inhibitors (some antifungals, certain antibiotics, grapefruit juice in large amounts) cause Nurtec to build up in your system. If you take one of these, you need to wait at least 48 hours before your next Nurtec dose instead of the usual schedule.
- Strong CYP3A4 inhibitors (including certain HIV medications and antifungals like ketoconazole) raise Nurtec levels so significantly that combining them should be avoided altogether.
- Strong or moderate CYP3A inducers (such as some seizure medications and the herbal supplement St. John’s wort) have the opposite problem. They break down Nurtec too quickly, potentially making it ineffective.
If you take any of these types of medications regularly, your prescriber will need to adjust your Nurtec plan or consider an alternative.
Liver and Kidney Considerations
Mild or moderate liver and kidney problems don’t require a dose change. However, people with severe liver impairment should avoid Nurtec because the drug reaches much higher levels in their bloodstream than intended. The same applies to people with end-stage kidney disease, since Nurtec hasn’t been studied in that population.