Zomig vs. Ubrelvy

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

Key Takeaways

  • Zomig is a triptan that narrows blood vessels to stop a migraine, while Ubrelvy is a gepant that blocks CGRP without affecting blood vessels.

  • Zomig comes in tablet, orally disintegrating tablet, and nasal spray forms, while Ubrelvy is only available as an oral tablet.

  • Zomig is contraindicated in heart disease and stroke risk due to its vasoconstrictive action, whereas Ubrelvy can be an option for those patients.

Zomig vs. Ubrelvy Drug Summary

Zomig

Zomig (zolmitriptan) is a triptan used for the acute treatment of migraine attacks in adults. It works by narrowing blood vessels around the brain and blocking pain signals, and comes as a tablet, orally disintegrating tablet, or nasal spray. It is taken as needed when a migraine starts, not as a daily preventive.

Ubrelvy

Ubrelvy (ubrogepant) is a CGRP receptor antagonist, or gepant, used for the acute treatment of migraine attacks in adults. It works by blocking a protein involved in migraine pain without narrowing blood vessels, and is taken as an oral tablet. A second dose can be taken at least two hours after the first if the migraine returns.

Zomig vs. Ubrelvy Side Effects

Zomig

Most common
asthenia (up to 14%)
nausea (up to 12%)

Ubrelvy

Most common
nausea (up to 4%)
somnolence (up to 3%)

Zomig vs. Ubrelvy Dosage

Zomig

Dosage
Dosage Table
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

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

Zomig vs. Ubrelvy Indications

Zomig

Zomig is FDA-approved to treat migraine attacks with or without aura once they start, not to prevent them. Available since 1997 in tablet, orally disintegrating tablet, and nasal spray forms, it gives patients options depending on how fast they need relief or whether nausea makes swallowing hard. It is not approved for cluster headache or in children under 12.

  • Acute treatment of migraine with or without aura

  • Available as tablet, ODT, or nasal spray

  • Not approved for migraine prevention

  • Not approved for cluster headache

  • Not approved for children under 12

Ubrelvy

Ubrelvy is FDA-approved to treat migraine attacks with or without aura once they start, not to prevent them. Approved in 2019, it is available only as an oral tablet and works through a different mechanism than triptans, making it an option for people who cannot take vasoconstrictive medications. It is not approved for prevention or use in children.

  • Acute treatment of migraine with or without aura

  • Available only as an oral tablet

  • Not approved for migraine prevention

  • Not approved for pediatric patients

  • Avoid in severe renal impairment

Zomig vs. Ubrelvy Pros and Cons

Zomig

Zomig has been used for acute migraine relief since 1997 and offers three formulations, including a nasal spray for people with nausea or vomiting during attacks. Because it narrows blood vessels, it carries cardiovascular risks that CGRP antagonists like Ubrelvy do not share.

Pros

  • Three formulations: tablet, ODT, and nasal spray

  • Nasal spray option works fast if pills are hard to swallow

  • Long safety track record since 1997

  • Lower-cost generic tablets available for many patients

Cons

  • Contraindicated in coronary artery disease and stroke history

  • Vasoconstrictive action carries cardiovascular risk

  • Risk of serotonin syndrome with SSRIs or SNRIs

  • More reported side effects like dizziness and drowsiness

Ubrelvy

Ubrelvy works by blocking a CGRP receptor rather than narrowing blood vessels, making it an option for people with heart disease, stroke history, or other cardiovascular risk factors who cannot take triptans. It is only available as an oral tablet and requires attention to drug interactions with CYP3A4 inhibitors.

Pros

  • No vasoconstriction, an option for cardiovascular risk patients

  • Simple as-needed dosing without titration

  • Fewer reported side effects in clinical trials

  • Second dose available if first doesn't fully work

Cons

  • Only available as an oral tablet, no nasal or spray option

  • Requires dose adjustment with CYP3A4 inhibitors or grapefruit juice

  • Not recommended in end-stage renal disease

  • New-onset hypertension or Raynaud's phenomenon possible

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