What Are Gepants?

Gepants are relatively new medications used to treat migraines. They belong to a class of medications known as calcitonin gene-related peptide (CGRP) inhibitors. CGRP is a molecule that is chemically created in neurons of the brain and spinal cord. It can trigger pain processes like migraines and also functions like a vasodilator. CGRP inhibitors work by blocking CRGP from attaching to its receptors and initiating pain signals.

Oral gepants are taken by mouth, either in the form of a tablet that is swallowed or a tablet that disintegrates on the tongue. They are generally taken at the first sign of a migraine attack or when migraine pain starts.

The first oral gepant approved to treat migraines with or without aura was ubrogepant, which received approval from the U.S. Food and Drug Administration (FDA) in December 2019. In February 2020, the FDA also approved rimegepant to treat acute migraines with or without aura. While ubrogepant and rimegepant are used to treat migraine attacks in progress, another gepant, atogepant, is being studied as a possible preventive medication.

Gepants may be beneficial for individuals with migraines who are unable to tolerate another class of migraine medications, triptans, due to allergies or side effects. They may also be an option for individuals who do not receive adequate relief from other migraine treatments or for those at a greater risk for conditions affecting the heart or the blood vessels in the brain. Unlike triptans, gepants do not constrict arteries in the heart or brain, so they are considered to be safer for individuals with related risk factors.

Oral gepants are generally well-tolerated. The most common side effects are nausea, dry mouth, tiredness and dizziness.