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Other related names or treatments

Qulipta, Atogepant

About Aquipta

Atogepant is a calcitonin gene-related peptide (CGRP) receptor antagonist, also known as a gepant. It works by blocking the activity of CGRP, a molecule involved in migraine. By blocking the CGRP receptor, Aquipta can help reduce migraine symptoms and prevent migraine attacks.

Aquipta is now used for both the acute treatment of migraine attacks and the preventive treatment of migraine in adults. It is available on prescription only. NowPatient offers Aquipta following an online consultation with a prescribing clinician to assess whether it is a suitable treatment option for you.

Key facts about Aquipta

• For the acute treatment of migraine with or without aura in adults
• For the preventive treatment (prophylaxis) of migraine in adults who have at least 4 migraine days per month
• For acute treatment, Aquipta is taken when a migraine attack occurs, rather than every day
• For migraine prevention, Aquipta is taken once daily
• The recommended dose for acute treatment is 60 mg as needed, with a maximum of 60 mg in a 24-hour period
• Aquipta has some common side effects, including nausea, constipation, fatigue or sleepiness, decreased appetite and weight loss
• Aquipta can interact with certain medicines, including strong CYP3A4 inhibitors and strong OATP inhibitors, which may require a lower dose

Who is Aquipta suitable for?

Aquipta is suitable for adults aged 18 years and over.

For the prevention of migraine, it is intended for adults who have at least 4 migraine days per month and only if at least 3 preventive medicines have not worked, or are not tolerated or are unsuitable because of safety concerns.

For acute treatment of migraine, In the UK, NICE recommends atogepant as an option for adults when, for previous migraine attacks:

• At least 2 triptans have been tried and have not worked well enough, or
• Triptans are contraindicated or not tolerated, and
• NSAIDs and paracetamol have been tried but have not worked well enough.

Who is Aquipta not suitable for?

Aquipta may not be suitable for some people. To make sure it is safe for you, speak to the prescribing clinician before taking Aquipta if you:

• Have ever had an allergic reaction to atogepant or any of the ingredients in Aquipta
• Have severe liver disease
• Have severe kidney disease or end-stage renal disease
• Are taking certain strong CYP3A4 inhibitors, such as ketoconazole, itraconazole, voriconazole or clarithromycin
• Are taking strong OATP inhibitors, such as rifampicin or ciclosporin
• Are pregnant or planning to become pregnant
• Are breastfeeding
• Are under 18 years of age
• Are 80 years of age or above

How and where to get Aquipta?

You can buy Aquipta safely and securely from NowPatient. You can start a consultation today for free and, if you qualify for treatment, you only pay for the cost of the medication. Delivery is made to your home or office from our registered pharmacy.

Our service is designed to provide access to treatment following an online clinical consultation. If you book a consultation for migraine treatment, you can discuss whether Aquipta is a suitable treatment option for you.

At the end of the consultation, the prescribing clinician will decide whether treatment is appropriate. If it is, the clinician will issue a prescription which can then be ordered, paid for and delivered directly to your chosen address by NowPatient.

Dosage and strength for Aquipta for Migraines

Aquipta is available as tablets containing 10 mg or 60 mg of atogepant.

For acute treatment of migraine, the recommended dose is 60 mg taken as needed, with a maximum dose of 60 mg in 24 hours.

For preventive treatment of migraine, the recommended dose is 60 mg once daily.

However, a lower dose of 10 mg is recommended when Aquipta is taken with certain strong CYP3A4 inhibitors or strong OATP inhibitors, and in patients with severe renal impairment or end-stage renal disease.

Information about how to take Aquipta for Migraines

Aquipta is taken orally and can be taken with or without food.

For acute Migraine treatment

Take Aquipta when you have a migraine attack, as directed by your prescribing clinician. Do not exceed one tablet in 24 hours. For acute treatment, Aquipta is available in pack sizes of 2 and 7.

For Migraine prevention

Take Aquipta once daily, preferably at approximately the same time each day. Do not exceed one tablet in 24 hours.

If you miss a preventive dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the next dose as scheduled. Do not take a double dose to make up for a forgotten tablet.

Do not change your dose or stop preventive treatment without speaking to your prescribing clinician.

Read the patient information leaflet supplied with your medication or speak to a healthcare professional if you need further advice.

What happens if you take too much Aquipta?

There is no known antidote for Aquipta. If you take more than prescribed, you should seek medical attention immediately. Treatment of an overdose should consist of general supportive measures including monitoring of vital signs and observation of the clinical status.

What are the side effects of Aquipta?

Side effects of Aquipta include common, uncommon and serious adverse reactions.

Common side effects (may affect up to 1 in 10 people) include:

• Nausea
• Constipation
• Fatigue
• Somnolence (sleepiness)
• Decreased appetite
• Weight decreased

Uncommon side effects (may affect up to 1 in 100 people) include:

• Increased liver enzymes (ALT/AST)

Rare side effects include:

• Anaphylaxis (a severe allergic reaction)

Most reported gastrointestinal side effects in preventive-treatment studies were mild, and nausea, constipation and fatigue/sleepiness were among the most commonly reported adverse reactions.

If you experience troublesome or persistent side effects, contact your prescribing clinician or pharmacist for advice.

If you experience signs of a serious allergic reaction, stop taking Aquipta and seek emergency medical attention by calling your local emergency number.

Signs can include:

• Swelling of the face, lips, tongue or throat
• Difficulty breathing or swallowing
• Severe rash, itching or hives
• Feeling faint or dizzy
• Rapid heartbeat

Some hypersensitivity reactions can occur several days after taking Aquipta, so remain alert for delayed symptoms.

Always report adverse effects to the reporting system run by your national medicines regulator. You can read more about this here: How and where do I report side effects of my medication?

Information about taking Aquipta at the same time as other medications or herbal supplements

Aquipta can interact with certain medicines. Tell your prescribing clinician about all medicines, supplements and herbal products you take.

Strong CYP3A4 inhibitors may require the Aquipta dose to be reduced to 10 mg once daily. Examples include:

• Ketoconazole
• Itraconazole
• Voriconazole
• Clarithromycin
• Telithromycin
• HIV protease inhibitors (indinavir, nelfinavir, ritonavir, saquinavir)

Strong OATP inhibitors may also require a dose of 10 mg once daily.

Examples include:

• Rifampicin
• Atazanavir
• Ritonavir
• Tipranavir
• Ciclosporin
• Telmisartan

Strong or moderate CYP3A4 inducers may reduce exposure to atogepant and potentially reduce its effectiveness. Examples include:

• Rifampicin with repeated dosing
• Carbamazepine
• Phenytoin
• Phenobarbital
• St John’s wort

Aquipta has not shown clinically significant interactions with medicines including oral contraceptives, paracetamol, naproxen, sumatriptan, topiramate, famotidine or esomeprazole.

Can Aquipta be taken for Migraines long term?

Aquipta can be used as a long-term preventive treatment for migraine, but treatment should be reviewed regularly to assess whether it remains appropriate.

For preventive treatment, In the UK, NICE recommends stopping atogepant after 12 weeks if the frequency of migraine does not reduce by:

• At least 50% for episodic migraine (fewer than 15 headache days per month), or
• At least 30% for chronic migraine (15 or more headache days per month).

For acute treatment, Aquipta is taken only when needed for a migraine attack rather than as a daily preventive treatment. NICE’s recommendation for acute treatment applies to adults who meet the specific previous-treatment criteria described above.

Is there a herbal Aquipta?

No. There is no herbal version of Aquipta. If you have been offered a product described as “herbal Aquipta” or a herbal version of atogepant, it may not be a genuine licensed medicine.

Can women use Aquipta?

Women can take Aquipta where it has been assessed as appropriate for migraine treatment.

Aquipta is not recommended during pregnancy because there are limited data on its use in pregnant women and animal studies have shown reproductive toxicity.

Atogepant passes into breast milk in small amounts, but there are currently limited data about its effects on breastfed infants or milk production. If you are breastfeeding, speak to your doctor or prescribing clinician before taking Aquipta.

If you are pregnant, breastfeeding or planning to become pregnant, discuss this with your healthcare professional before taking Aquipta.

Should I avoid any particular food or drink when taking Aquipta?

Aquipta can be taken with or without food and there are no specific dietary restrictions associated with its use.

However, you should tell your prescribing clinician about any supplements or herbal products you take, including St John’s wort, because it can interact with atogepant.

What are the non-active ingredients in Aquipta?

Aquipta contains the following non-active ingredients (excipients):

• Polyvinylpyrrolidone/vinyl acetate copolymer
• Vitamin E polyethylene glycol succinate
• Mannitol
• Microcrystalline cellulose
• Sodium chloride
• Croscarmellose sodium
• Colloidal silicon dioxide
• Sodium stearyl fumarate
• While lactose-free, Aquipta 60 mg tablets contain 31.5 mg of sodium per tablet.

What lifestyle changes can I make to help me with Migraines?

• Maintain regular sleep patterns
• Exercise regularly
• Eat regular, healthy meals
• Stay well hydrated
• Reduce stress through relaxation techniques such as mindfulness or meditation
• Avoid known migraine triggers
• Keep a headache diary to identify patterns and triggers

Lifestyle measures can be useful alongside prescribed migraine treatment.

Alternatives to Aquipta

The most appropriate alternative depends on whether treatment is required for acute migraine attacks or migraine prevention.

For acute migraine treatment, options may include triptans, NSAIDs and paracetamol. In the UK, NICE recommends atogepant as an option for adults whose previous migraine treatment meets the specific criteria outlined in NICE TA1172. Another CGRP receptor antagonist, rimegepant, may also be an option in appropriate patients.

For preventive treatment, alternatives include other CGRP-targeting medicines such as erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality) and eptinezumab (Vyepti), as well as oral preventive medicines such as propranolol, topiramate and amitriptyline. In the UK, NICE recommends CGRP-targeting preventive treatments in appropriate adults who have at least 4 migraine days per month and for whom at least 3 preventive medicines have not worked, are not tolerated or are unsuitable because of safety concerns.

Sources

• NHS conditions migraine
• EMC Summary of Product Characteristics – Aquipta
• European Medicines Agency – Aquipta
• NICE Technology Appraisal Guidance TA973 – Atogepant for preventing migraine