Ubrelvy vs. Ajovy

See how Ubrelvy and Ajovy compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Ubrelvy treats a migraine attack after it starts, while Ajovy is taken on a schedule to prevent migraines before they begin.

  • Ubrelvy is a tablet swallowed as needed, while Ajovy is a self-injection given once monthly or once every three months.

  • Both drugs target the CGRP pathway linked to migraine, but they work in different ways and are not interchangeable for the same purpose.

Ubrelvy vs. Ajovy Drug Summary

Ubrelvy

Ubrelvy (ubrogepant) is an oral CGRP receptor antagonist, a type of drug called a gepant, used to treat migraine attacks as they happen. It's FDA-approved for acute treatment of migraine with or without aura in adults, taken as a single tablet with an optional second dose if the first doesn't fully work.

Ajovy

Ajovy (fremanezumab-vfrm) is a CGRP-targeting monoclonal antibody given by injection to prevent migraines before they start. It's FDA-approved for preventive treatment of migraine in adults, dosed as a single subcutaneous injection either once a month or once every three months.

Ubrelvy vs. Ajovy Side Effects

Ubrelvy

Most common
nausea (4% vs 2% placebo)

Ajovy

Most common
injection site reactions (38% to 45%)

Ubrelvy vs. Ajovy Dosage

Ubrelvy

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 50 mg or 100 mg At the start
Maximum dose 2nd dose: 50 or 100 mg If needed
Dose changes 1 increase As tolerated

Ajovy

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 225 mg At the start
Maximum dose 675 mg If needed
Dose changes 1 increase As tolerated

Ubrelvy vs. Ajovy Indications

Ubrelvy

Ubrelvy is approved to treat a migraine attack once it has already started, with or without aura, in adults. It is not intended to prevent migraines from occurring and is not approved for use in children.

  • Acute treatment of migraine with or without aura in adults

  • Taken as needed at the first sign of an attack

  • Second dose allowed if the first isn't fully effective

  • Not approved for preventive use

Ajovy

Ajovy is approved to prevent migraines before they occur in adults, and in adolescents 6 to 17 years old weighing at least 45 kg with episodic migraine. It is not intended to stop a migraine attack that has already begun.

  • Preventive treatment of migraine in adults

  • Approved for episodic migraine in patients 6-17 (≥45 kg)

  • Given by monthly or quarterly injection

  • Not approved for treating an active attack

Ubrelvy vs. Ajovy Pros and Cons

Ubrelvy

Ubrelvy gives patients a fast-acting oral option they can take only when a migraine actually strikes, without a fixed dosing schedule. Its interactions with CYP3A4 drugs and lack of a preventive indication are its main practical limits.

Pros

  • Oral tablet, no injection required

  • Taken only when needed, not on a fixed schedule

  • Second dose available same day if needed

  • No dose adjustment for mild or moderate kidney impairment

Cons

  • Does not prevent migraines from occurring

  • Contraindicated with strong CYP3A4 inhibitors

  • Dose must be adjusted around grapefruit juice and certain other drugs

  • Requires taking a pill at every attack, which some patients find harder to remember

Ajovy

Ajovy is built for prevention, reducing how often migraines occur rather than treating one already underway. Its main tradeoffs are frequent injection site reactions and the need for self-injection instead of a pill.

Pros

  • Only needs to be injected monthly or every 3 months

  • Designed to reduce migraine frequency over time

  • Quarterly dosing option not offered by most CGRP antibodies

  • Long half-life keeps drug levels steady between doses

Cons

  • Injection site reactions are very common

  • Requires self-injection rather than a pill

  • Does not treat a migraine attack already in progress

  • No generic or biosimilar version currently available

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