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
Ajovy
Ubrelvy vs. Ajovy Dosage
Ubrelvy
Ajovy
| 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 |
| STAGE | DOSE | WHEN |
| Starting dose | 225 mg | At the start |
| Maximum dose | 675 mg | If needed |
| Dose changes | 1 increase | As tolerated |
Ubrelvy
| 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
| 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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