Zomig vs. Nurtec
See how Zomig and Nurtec compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Zomig is a triptan that narrows blood vessels to stop a migraine already in progress, while Nurtec blocks CGRP and can both treat an attack and prevent future ones.
Zomig is contraindicated in people with heart disease or stroke history because of its vasoconstrictive action, a restriction Nurtec does not carry.
Nurtec's side effect rates in trials were much lower than Zomig's, but it has no generic option and typically costs more each month.
Zomig vs. Nurtec Drug Summary
Zomig
Zomig (zolmitriptan) is a triptan that treats acute migraine attacks by narrowing blood vessels and calming overactive pain signals. It comes as a tablet, an orally disintegrating tablet, or a nasal spray, taken at the first sign of a migraine and repeated after two hours if the headache returns.
Nurtec
Nurtec (rimegepant) is a CGRP receptor antagonist that treats migraine attacks and can also prevent episodic migraine using the same orally disintegrating tablet. It dissolves on the tongue and is taken as needed for an attack or every other day for prevention.
Zomig vs. Nurtec Side Effects
Zomig
Nurtec
Zomig vs. Nurtec Dosage
Zomig
Nurtec
| STAGE | DOSE | WHEN |
| Starting dose | 1.25 mg or 2.5 mg | At the start |
| Maximum dose | 5 mg as single dose | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 75 mg as needed | At the start |
| Maximum dose | 75 mg every other day | If needed |
| Dose changes | 1 increase | As tolerated |
Zomig
| STAGE | DOSE | WHEN |
| Starting dose | 1.25 mg or 2.5 mg | At the start |
| Maximum dose | 5 mg as single dose | If needed |
| Dose changes | 2 increases | As tolerated |
Nurtec
| STAGE | DOSE | WHEN |
| Starting dose | 75 mg as needed | At the start |
| Maximum dose | 75 mg every other day | If needed |
| Dose changes | 1 increase | As tolerated |
Zomig vs. Nurtec Indications
Zomig
Zomig is approved for the acute treatment of migraine with or without aura in adults. It is meant to stop a migraine that has already started, not to prevent future attacks.
Treats acute migraine attacks with or without aura
Available as a tablet, orally disintegrating tablet, or nasal spray
Approved for adults only; tablet and ODT not approved under age 12
Not approved for migraine prevention or cluster headache
Nurtec
Nurtec is approved for the acute treatment of migraine with or without aura and for preventing episodic migraine in adults. The same orally disintegrating tablet is used for both purposes, just on different schedules.
Treats acute migraine attacks with or without aura
Also approved to prevent episodic migraine in adults
Same ODT formulation used for both acute and preventive dosing
Not approved for chronic migraine prevention or cluster headache
Zomig vs. Nurtec Pros and Cons
Zomig
Zomig has decades of real-world use and comes in three forms, which helps patients who have trouble swallowing pills during an attack or who have nausea. Because it works by narrowing blood vessels, it is not an option for people with heart disease or a history of stroke.
Pros
Available as tablet, ODT, or nasal spray for faster options during an attack
Long track record of use since FDA approval in 1997
Generic tablet form can cost far less than Nurtec, roughly $13 to $1,332 a month depending on formulation and coverage
Nasal spray option works well for people with migraine-related nausea or vomiting
Cons
Contraindicated in people with coronary artery disease or history of stroke
Higher rates of dizziness, paresthesia, and asthenia in trials than Nurtec
Not approved to prevent migraines, only to stop an active attack
Short half-life may mean a second dose is needed for some attacks
Nurtec
Nurtec's mechanism does not constrict blood vessels, so it avoids the cardiovascular restrictions that limit triptans like Zomig. It is the only oral CGRP option approved for both stopping an active migraine and preventing future ones with a single formulation.
Pros
Not contraindicated for people with heart disease or stroke history
Can be used both to treat an attack and to prevent episodic migraine
Notably lower rates of nausea and other side effects in clinical trials
Dissolves on the tongue without water, useful during an attack
Cons
No generic version available, typically $1,000 to $1,376 a month without insurance
Risk of hypersensitivity reactions, including anaphylaxis, sometimes days after a dose
Must avoid strong CYP3A4 inhibitors, which limits use with certain other medications
Not approved for chronic migraine prevention
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