Nurtec (rimegepant) causes relatively few side effects compared to older migraine medications. In clinical trials, fewer than 3% of patients reported any side effect. The most common one is nausea, and serious reactions are rare but possible.
Nurtec is FDA-approved both for treating migraines when they strike and for preventing them when taken every other day. The side effect profile is slightly different depending on how you use it.
Common Side Effects
Nausea is the most frequently reported side effect of Nurtec regardless of how it’s used. In the acute treatment trial, 2% of patients experienced nausea compared to 0.4% on placebo. In the prevention trial, where patients took Nurtec every other day, the nausea rate was similar at 2.7% versus 0.8% on placebo.
Stomach pain and indigestion showed up more often during preventive use, affecting 2.4% of patients compared to 0.8% on placebo. This makes sense given the more frequent dosing schedule. These digestive symptoms are generally mild and tend to be manageable for most people.
Notably, some side effects commonly associated with older migraine drugs don’t appear with Nurtec. Weight gain has not been reported in studies of either acute or preventive use. Drowsiness, which is common with many migraine treatments, was not reported at significant rates in clinical trials either.
Allergic Reactions
The most important safety concern with Nurtec is the possibility of a hypersensitivity reaction. These have included difficulty breathing and rash in clinical studies. What makes this worth knowing is the timeline: allergic reactions can show up days after taking a dose, not just immediately. This delayed onset means you could take Nurtec, feel fine, and then develop symptoms like facial swelling, throat tightness, or trouble breathing several days later.
If you experience swelling of the face, mouth, tongue, or throat, or any difficulty breathing after taking Nurtec, that warrants emergency medical attention. Anyone who has had a hypersensitivity reaction to Nurtec should not take it again.
How Nurtec Compares to Triptans
One of the reasons Nurtec has gained popularity is its side effect profile relative to triptans, the class of drugs that dominated migraine treatment for decades. Triptans work by activating serotonin receptors, which tightens blood vessels. That mechanism relieves migraines effectively but creates cardiovascular risks, making triptans off-limits for people with a history of stroke or heart disease.
Nurtec works through a completely different pathway, blocking a protein involved in migraine pain signaling rather than constricting blood vessels. This means it carries fewer cardiovascular concerns and can be an option for people who couldn’t safely use triptans. Triptans also commonly cause chest tightness, tingling, and drowsiness, side effects that aren’t characteristic of Nurtec.
Drug Interactions That Increase Side Effects
Certain medications can raise the level of Nurtec in your bloodstream, potentially increasing the chance of side effects. The main culprits are drugs that interfere with how your liver breaks down Nurtec.
- Strong CYP3A4 inhibitors: These include certain antifungal medications and some HIV treatments. Using these with Nurtec significantly increases its concentration in your body, and the combination should be avoided entirely.
- Moderate CYP3A4 inhibitors: These can also raise Nurtec levels. If you take one of these medications, you should wait at least 48 hours before taking another dose of Nurtec.
- P-gp inhibitors: Drugs like cyclosporine, quinidine, and ranolazine fall into this category. The same 48-hour spacing between Nurtec doses applies when using these.
If you’re taking any prescription medications regularly, it’s worth checking whether they fall into one of these categories before starting Nurtec.
Pregnancy and Breastfeeding
There isn’t enough human data to know whether Nurtec is safe during pregnancy. Animal studies showed decreased fetal body weight and developmental variations at doses higher than what humans take, though these effects occurred alongside toxicity in the mothers as well. A pregnancy registry exists to track outcomes in women who take Nurtec during pregnancy, which means data is still being collected.
For breastfeeding, the picture is similarly incomplete. No studies have measured whether Nurtec passes into breast milk, what effect it might have on a nursing infant, or whether it affects milk production. There isn’t even animal data on this point. The decision to use Nurtec while breastfeeding comes down to weighing the benefit of migraine control against the unknown risk to the infant.