Vydura (Rimegepant)

What is Vydura?

Vydura contains rimegepant, a medicine that targets a migraine pathway linked to pain signalling. It comes as a 75 mg orally disintegrating lyophilisate (freeze-dried wafer) that dissolves quickly in the mouth. Vydura is a reliable option for individuals who find basic pain relief (such as paracetamol and ibuprofen) ineffective at treating migraines. It may also be a suitable option for those unable to take alternative migraine treatments such as triptans (e.g., sumatriptan).  

What is Vydura Used For?

Vydura is a prescription treatment for migraine in adults. It can be used in two ways, depending on how your clinician prescribes it to you: 

• To treat a migraine attack when it starts
• To help prevent migraines in people who get frequent attacks

The medication can be used for migraine with or without aura. For prevention, the National Institute for Health and Care Excellence (NICE) recommends prescribing it for adults with at least 4 but fewer than 15 migraine attacks per month, after at least 3 other preventive medicines have not worked or have been unsuitable.

For treating acute attacks, NICE recommends rimegepant (the active ingredient in Vydura) as a suitable treatment option when either:

• At least 2 triptan medications have not worked well enough
• Triptans are unsuitable for use, and non-steroidal anti-inflammatory (NSAIDs), such as ibuprofen, and paracetamol, have been tried without sufficient benefit

Your prescriber will use the best available evidence to determine whether Vydura may be an appropriate treatment option for you.

Vydura (Rimegepant) Mechanism of Action 

Migraine is a neurological condition that involves more than head pain alone. During an attack, the body releases chemicals that amplify pain and sensitivity. One of the key pain-signalling substances involved in migraine is CGRP (calcitonin gene-related peptide).

CGRP is involved in sending and strengthening pain signals and is thought to contribute to the inflammation-like changes that occur during migraine. Vydura works by blocking CGRP receptors, thereby interrupting this process and reducing the impact of CGRP during a migraine. This can help ease migraine pain and associated symptoms such as nausea and sensitivity to light and sound. 

In practical terms, Vydura is designed to reduce a specific migraine-related pain signal, rather than narrowing blood vessels (which is how many other migraine medications work). 

How Does Rimegepant Work for Migraine Prevention?

Much like when prescribed for the acute relief of migraine, rimegepant migraine prevention regimens target the same CGRP mechanism. This pathway is responsible for amplifying the pain experienced during a migraine (and increasing your sensitivity to them). By regularly blocking CGRP receptors over a period of time, rimegepant can prevent CGRP from triggering a migraine. As a result, you may experience fewer attacks in a month than you would have previously. You may also find that headaches are less likely to progress to debilitating migraines. 

How Long Does Vydura Take to Work?

How quickly Vydura (rimegepant) works can vary from person to person and may also depend on the severity of your symptoms. One study reported that 1 in 5 people who took Vydura were pain-free within 2 hours of taking the medication. It also showed that 35% were free from their most bothersome symptom within the same timeframe. Ultimately, Vydura should be taken at the first sign of migraine to effectively treat symptoms. 

How Effective is Vydura for Migraines?

Clinical trials have shown that rimegepant can be effective for both the treatment of migraine attacks and migraine prevention in adults.

In acute treatment, randomised controlled trials have shown that a single 75 mg dose of rimegepant provides pain relief within 2 hours in a significant proportion of patients. In one study, approximately 1 in 5 participants were pain-free at 2 hours, compared with approximately 1 in 10 participants taking a placebo. Relief from symptoms that often accompany migraine, such as nausea and sensitivity to light and sound, was also more common in those taking rimegepant.

When used as a preventative treatment, rimegepant has been shown to reduce the number of monthly migraine days. In one clinical study involving adults with frequent migraine, people taking rimegepant experienced an average reduction of around 4-5 migraine days per month. People taking a placebo also saw some improvement, with a reduction of around 3-4 migraine days per month. This means rimegepant reduced migraine frequency by approximately one additional day per month compared with placebo.

Response to treatment varies between individuals. Some people notice benefits early, whereas others may require ongoing use to fully assess effectiveness, particularly when the medication is prescribed for migraine prevention. 

How to Take Vydura

Vydura is taken as an orally disintegrating lyophilisate (freeze-dried wafer). Place it on or under the tongue and allow it to dissolve. It can be taken with or without food or water (but you must still allow the wafer to fully dissolve). Depending on your prescription, it may be taken at the start of a migraine attack or on a regular schedule for prevention.

Do not chew or crush the wafer. Allow it to dissolve completely before swallowing; this should only take a few seconds. If you are unsure about how to take Vydura, speak to your clinician or pharmacist for advice.

When removing Vydura from the blister pack, use dry hands to peel back the foil covering. Do not push the wafer through the foil. Place the medication on or under the tongue as soon as the blister is opened. 

Vydura Dosage Information

Vydura is supplied as a 75 mg lyophilisate. Your clinician will advise you on how to take it, depending on whether you’re using it for acute treatment, prevention, or a combination approach.

For migraine prevention, the usual dose is one 75mg lyophilisate every other day. When taking Vydura as needed for migraine relief, you can only take a maximum of one dose (75mg) in 24 hours. Never exceed the maximum recommended dose. 

What if You Forget to Take Vydura

If you take Vydura for prevention and you miss a dose, take the next dose at the usual time. Do not take a double dose to make up for a forgotten one. Do not take more than one dose (75mg) a day.

If you forget to take Vydura during a migraine attack, and you have not taken Vydura in the previous 24 hours, take it as soon as you remember if you are still experiencing symptoms. 

What if You Take Too Much Vydura 

If you take more Vydura than you should (over 75mg in one day), speak to your doctor or attend your local emergency department straight away. You should take the medicine pack and Patient Information Leaflet with you when you attend the hospital. 

Vydura Side Effects and Cautions

Like all medications, Vydura (Rimegepant) has the potential to cause side effects, though not everyone will experience them. Adverse reactions were observed both when the medication was used to treat acute migraines and as a preventative measure (prophylaxis). 

Vydura (Rimegepant) Side Effects 

Certain immune system and gastrointestinal disorders have been observed. Nausea is the most commonly reported side effect, affecting up to 1 in 10 people who take Vydura.

Hypersensitivity and severe allergic reactions (anaphylaxis) are uncommon and may affect up to 1 in 100 people who take Vydura. Symptoms include shortness of breath and severe rash. These reactions can occur days after administration, and delayed serious hypersensitivity has also been reported.

A more detailed explanation can be found within the Patient Information Leaflet that accompanies the medication. If you do experience any adverse reactions to the treatment, you can also report them using the MHRA’s Yellow Card Scheme. 

When to Stop Taking Vydura

You should stop taking Vydura and contact your clinician or doctor immediately if you experience signs of an allergic reaction or a severe allergic reaction known as “anaphylaxis”.

Symptoms to look out for include:

• Severe rash
• Shortness of breath
• Swelling of the tongue, mouth, or face
• Trouble swallowing or breathing
• Throat tightness
• Hoarseness

These symptoms can occur several days after administration. More information regarding Vydura side effects can be found within the Patient Information Leaflet that comes with the medication. 

Vydura Interactions and Warnings

You should not take Vydura if you are allergic to Rimegepant or any of the other ingredients in the medication (gelatin, mannitol, mint flavour, and sucralose). It’s also important to consult your clinician or doctor before starting treatment if you have:

• Severe liver problems
• Reduced kidney function or are on kidney dialysis

If you experience any symptoms of an allergic reaction during treatment, stop taking Vydura and seek immediate medical attention. 

Vydura and Other Medicines

You must tell your prescriber if you are taking or have recently taken any prescription medications, over-the-counter treatments, supplements, or herbal remedies. Some medicines may affect the way Vydura works, or Vydura may affect how other medicines work. Do not take Vydura if you are taking:

• Itraconazole and clarithromycin (used to treat fungal or bacterial infections)
• Ritonavir and efavirenz (used to treat HIV infections)
• Bosentan (used to treat high blood pressure)
• St. John’s Wort (a herbal remedy)
• Phenobarbital (used to treat epilepsy)
• Rifampicin (used to treat tuberculosis)
• Modafinil (used to treat narcolepsy)

You should not take Vydura more than once every 48 hours if you take:

• Fluconazole and erythromycin (used to treat fungal or bacterial infections)
• Diltiazem, quinidine, and verapamil (used to treat an abnormal heart rhythm, chest pain (angina), or high blood pressure)
• Cyclosporin (used to prevent organ rejection after an organ transplant).

Pregnancy and Breastfeeding

If you are pregnant, may be pregnant, or may become pregnant, speak to your doctor or pharmacist for advice before taking Vydura. The effects of Vydura during pregnancy are unknown, so it’s preferable to avoid using this product if possible. If you are breastfeeding or planning to breastfeed, speak to your doctor before using Vydura to ensure that it is right for you.  

Frequently Asked Questions About Vydura (Rimegepant)