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Calcitonin gene-related peptide receptors (CGRP) receptor antagonists and monoclonal antibodies against CGRP and its receptor are medications used in the management and treatment of migraine, which is the sixth-highest cause worldwide of years lost due to disability as per the Global Burden of Disease Study (2013). This activity describes the indications, actions, and contraindications for these drugs as valuable agents in the prophylaxis and acute management of migraine and cluster headaches. This activity will highlight the mechanism of action, monitoring, adverse events, relevant interactions, and other key elements in the clinical setting as relates to the essential points needed by members of an interprofessional team managing the care of patients with migraines. Objectives: Summarize the role of RAMP1 in the formation of the CGRP receptor. Outline the currently FDA-approved drugs acting on CGRP or its receptor. Identify the most common adverse events associated with CGRP receptor antagonists. Review the importance of proper monitoring and coordination amongst interprofessional team members to improve outcomes for patients affected by migraine. Access free multiple choice questions on this topic.

There is limited clinical experience with drugs acting on CGRP or its receptor. However, treatment should include general supportive measures, including monitoring of the vital signs and observation of the general clinical status. There is no specific antidote for the toxicity of erenumab, eptinezumab, galcanezumab, fremanezumab, rimegepant or, ubrogepant.[13][9][10][11][15][16] For rimegepant, dialysis is unlikely to remove rimegepant significantly due to its high serum protein binding.[15] Since the half-life of ubrogepant elimination is about 5 to 7 hours, patient monitoring after ubrogepant overdose should continue while symptoms or signs persist or for a minimum of 24 hours.[16]

Since the studies regarding CGRP and its receptor, physiology, and pharmacology were conducted relatively recently, there is much unknown about it. The new drugs acting on the CGRP receptor have greater efficacy and advantages over the drugs currently used for the treatment of migraines, which may lead to the widespread use of these new drugs. However, professionals within the field of internal medicine and neurology have to take care while prescribing these drugs and properly inform patients about the potential side effects of these medications. Watching for adverse effects reported in previous studies and preparing for those that have not yet been described is also vital. Drug interactions and comorbidities also affect the dosage of gepants, so they should also undergo periodic assessment; this requires proper coordination between professionals in different specialties. In the case of mAbs such as erenumab, patient education by health providers is necessary for patient compliance. These medications need a prolonged time before any significant relief can be appreciated. The pharmacist will also need to perform medication reconciliation to address drug interactions and verify all dosing is appropriate. Finally, due to the debilitating nature of migraines, counselors, psychiatrists, neurologists, and other healthcare staff should all work together to ensure proper patient care. This interprofessional team support can help ensure appropriate medication usage, provide proper instructions to patients and/or caregivers, monitor treatment response, and care for the mental welfare of the patient and their family members. [Level 5]