Emgality is a once-monthly self-injection you give yourself at home, either with a prefilled pen (autoinjector) or a prefilled syringe. The process takes only a few minutes once you’re familiar with it, but the first time involves a loading dose of two injections instead of one. Here’s everything you need to know to do it correctly.
Dosing for Migraine Prevention
Your very first dose is a loading dose: 240 mg, which means two separate 120 mg injections given back to back on the same day. After that, you switch to a single 120 mg injection once a month. The loading dose helps the medication reach effective levels in your body faster, so you may start noticing fewer migraines sooner.
Dosing for Cluster Headaches
If you’re using Emgality for episodic cluster headaches, the dosing is different. You’ll take 300 mg at the onset of a cluster period, which means three consecutive injections of 100 mg each at one visit. You then repeat 300 mg (three injections) monthly until the cluster period ends. This higher dose reflects the different biology of cluster headaches compared to migraines.
Where to Inject
You have four approved injection sites to choose from: your abdomen, your thigh, the back of your upper arm, or your buttocks. The back of the arm and buttocks are harder to reach on your own, so you may need someone else to give the injection in those spots. Rotate your injection site each month, and avoid injecting into skin that’s bruised, tender, red, or hard.
How to Prepare the Medication
Emgality is stored in the refrigerator between 36°F and 46°F, in its original carton to protect it from light. Before injecting, take it out and let it sit at room temperature for 30 minutes. Injecting cold medication is more likely to sting. Don’t try to warm it up with a microwave, hot water, or any other heat source.
If you need to travel or can’t refrigerate it, Emgality can stay at room temperature (up to 86°F) for a maximum of 7 days. Once it’s been out of the fridge, don’t put it back in. If it’s been unrefrigerated for longer than 7 days or exposed to temperatures above 86°F, throw it away.
Before injecting, inspect the liquid through the viewing window. It should be clear to slightly yellow. If it looks cloudy, discolored, or has visible particles, don’t use it.
Using the Autoinjector Pen
The autoinjector is the more common device and the easier one to use. After letting it warm up for 30 minutes, wash your hands and clean your chosen injection site with an alcohol swab. Then follow these steps:
- Check the lock. Make sure the device is in the locked position. Don’t touch the needle end.
- Remove the base cap. Twist off the clear base cap and throw it away.
- Position the pen. Place the clear base flat and firm against your skin. You don’t need to pinch the skin with the autoinjector, thanks to its wide base.
- Unlock the device. Slide the lock to the unlocked position.
- Inject. Press the injection button and hold the pen firmly against your skin for 10 seconds. You’ll hear a click when the injection starts and another when it’s complete.
The clear body of the pen lets you see the medication leaving the device, so you can confirm the full dose was delivered. Once done, lift the pen straight off your skin and dispose of it in a sharps container. If you’re doing a loading dose, repeat the full process with a second pen at a different spot on your body.
Using the Prefilled Syringe
The prefilled syringe requires a bit more technique. After the same 30-minute warm-up and hand washing, pull the needle cap straight off (don’t twist it) and throw it away. Never put the cap back on. Gently pinch a fold of skin at your injection site and insert the needle at a 45-degree angle. Release the skin fold, then slowly push the plunger all the way down. Withdraw the needle and dispose of the syringe in a sharps container.
The key difference between the two devices: the syringe requires you to pinch the skin and control the needle angle yourself, while the autoinjector handles insertion automatically. In clinical comparisons, both devices deliver the same amount of medication with the same effectiveness.
What Side Effects to Expect
The most common side effect is a reaction at the injection site. In clinical trials, about 18% of people taking Emgality experienced some form of injection site reaction, compared to 13% on placebo. These reactions include temporary pain, redness, itching, or swelling where the needle went in. They’re typically mild and resolve on their own within a few days.
Letting the medication reach room temperature before injecting is one of the simplest ways to reduce discomfort. Some people also find that injecting into the thigh or abdomen (where there’s more subcutaneous fat) causes less stinging than other sites.
If You Miss a Dose
If you miss your scheduled monthly injection, take it as soon as you remember and then resume your regular monthly schedule from that new date. There’s no need to double up or take an extra dose. Because Emgality works by binding to a signaling protein involved in migraine and clearing it from your system, a short gap between doses won’t erase the protection you’ve already built up, but staying consistent gives you the best chance of steady migraine reduction.
Storage and Handling Tips
Keep your pens or syringes in the refrigerator until you’re ready to use them. Don’t freeze Emgality, and throw it away if it has been frozen. Always store it in the original carton to block light exposure. Check the expiration date on the carton before each injection. If you’re traveling, a small insulated bag with a cold pack works fine for short trips, just make sure the medication doesn’t freeze and doesn’t stay out of refrigeration for more than 7 days total.