Ubrelvy vs. Emgality

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

Key Takeaways

  • Ubrelvy is an oral tablet taken during a migraine attack, while Emgality is a once-monthly injection used to prevent migraines before they start.

  • Ubrelvy works within hours to treat a migraine already underway; Emgality takes weeks to build up its preventive effect and isn't for active attacks.

  • Emgality is also approved for episodic cluster headache, a use Ubrelvy does not have.

Ubrelvy vs. Emgality Drug Summary

Ubrelvy

Ubrelvy (ubrogepant) is an oral CGRP receptor antagonist used for the acute treatment of migraine, with or without aura, in adults. It's taken as a single tablet at the first sign of a migraine, with a second dose allowed at least 2 hours later if needed. It does not prevent migraines from occurring.

Emgality

Emgality (galcanezumab-gnlm) is a monoclonal antibody that blocks CGRP, given as a once-monthly injection to prevent migraines in adults. It's also FDA-approved to treat episodic cluster headache, using a higher monthly dose during a cluster period. It does not treat a migraine that has already started.

Ubrelvy vs. Emgality Side Effects

Ubrelvy

Most common
Nausea (up to 4%)
Somnolence (up to 3%)

Emgality

Most common
Injection site reactions (up to 18%)
Injection site pain (10.1% to 11.6%)

Ubrelvy vs. Emgality Dosage

Ubrelvy

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

Emgality

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 240 mg Day 1
Maximum dose 300 mg once monthly If needed
Dose changes 2 increases As tolerated

Ubrelvy vs. Emgality Indications

Ubrelvy

Ubrelvy is FDA-approved for the acute treatment of migraine with or without aura in adults. It's taken as needed when a migraine starts, not on a fixed schedule. It is not approved to prevent migraines or for use in children.

  • Acute treatment of migraine with aura

  • Acute treatment of migraine without aura

  • Not approved for migraine prevention

  • Not approved for pediatric patients

Emgality

Emgality is FDA-approved to prevent migraines in adults, reducing how often they occur. It's also approved to treat episodic cluster headache using a different, higher dose. It is not approved to treat an active migraine attack or for use in children.

  • Preventive treatment of migraine in adults

  • Treatment of episodic cluster headache in adults

  • Not approved for acute migraine treatment

  • Not approved for pediatric patients

Ubrelvy vs. Emgality Pros and Cons

Ubrelvy

Ubrelvy works fast as a rescue tablet for a migraine already underway, with no titration or loading dose required. It carries important drug interaction warnings, especially with CYP3A4 inhibitors, and may need dose adjustments in some patients. It does not reduce how often migraines occur.

Pros

  • Oral tablet, no injections needed

  • Taken only when a migraine strikes, no fixed schedule

  • Second dose available same day if the first doesn't fully work

  • No loading dose or titration period before it starts working

Cons

  • Must be taken with each attack, doesn't prevent migraines

  • Interacts with many common drugs metabolized by CYP3A4

  • Contraindicated with strong CYP3A4 inhibitors

  • Needs dose adjustment for severe kidney impairment

Emgality

Emgality is dosed just once a month after a single loading dose, making it convenient for long-term migraine prevention. It requires self-injection and takes time to reach full effect, so it isn't useful during an active migraine. It carries fewer drug interaction concerns since it isn't processed through the liver's CYP3A4 pathway.

Pros

  • Only needs to be dosed once a month after the first dose

  • Approved for both migraine prevention and cluster headache

  • First FDA-approved drug shown to reduce cluster headache attacks

  • Fewer drug interaction concerns than oral CGRP tablets

Cons

  • Requires self-injection, which some patients dislike

  • Needs a loading dose before reaching the regular monthly dose

  • Injection site reactions are common

  • Takes weeks to build up effect, not for an active migraine

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