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
Ubrelvy
Zomig vs. Ubrelvy Dosage
Zomig
Ubrelvy
| 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 | 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
| 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
| 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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