3 Ajovy Side Effects and How to Manage Them
Key takeaways:
Ajovy (fremanezumab) is an injectable medication that prevents migraines. It’s a type of medication called a calcitonin gene-related peptide (CGRP) antagonist.
The most common Ajovy side effects are injection site reactions, which include pain, swelling, or redness where Ajovy was injected. There are ways to manage these symptoms as well as prevent them during or after future injections.
Rashes, hives, and other allergic symptoms are unlikely, but they can happen. Get emergency care right away if you have trouble breathing or experience swelling of the face, mouth, or tongue after injecting Ajovy. These are possible symptoms of a severe allergic reaction.
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If you’ve ever experienced a migraine, you know that you’ll do nearly anything to prevent another one from starting. Thankfully, a number of medications are available to do just that.
Ajovy (fremanezumab) is one option. It’s a monoclonal antibody that’s FDA approved for the prevention of migraine headaches in adults ages 18 years and older. It’s a calcitonin gene-related peptide (CGRP) antagonist, which works by blocking certain cellular processes believed to be involved in causing migraines.
Ajovy is currently only available as a brand-name medication, and it may not be covered by insurance right away. But this self-injectable medication is an effective option for many people. The dosing of Ajovy — once per month or once every 3 months — is also convenient, which is a big plus.
Many people can take Ajovy without experiencing side effects. But just like with all medications, some Ajovy side effects are possible. Here are three side effects to be aware of if you use Ajovy.
1. Injection site reactions
Injection site reactions are the most common side effect of Ajovy. In clinical trials, up to 45% of people using Ajovy experienced an injection site reaction. These reactions were also the main reason why people stopped using the medication in clinical trials, although this didn’t occur often.
Symptoms of injection site reactions include pain, swelling, or redness at the area of injection. Sometimes, a lump under the skin may develop, too. This can resemble an allergic reaction, but these local reactions are a normal and expected side effect of most injectable medicines. If these symptoms develop all over the body (rather than just the injection site), that’s more concerning.
If you develop a fever, severe pain, or long-lasting discomfort, let your healthcare provider know right away. These can be symptoms of a more serious reaction or cellulitis (a bacterial skin infection) that need to be looked at right away.
2. Skin rashes and other allergic symptoms
Allergic symptoms — including skin rashes, hives, and itchiness — have been reported among some people using Ajovy. During clinical trials, these reactions occurred any time between 1 hour and 1 month after the injection.
Although these symptoms can be a nuisance, there are ways to manage them. Over-the-counter antihistamines, such as Benadryl (diphenhydramine), can help reduce itchiness and other minor allergic symptoms. These can be taken by mouth or applied as a cream directly to the skin at the site of the reaction.
Other reactions are more serious. It’s best to get emergency care right away if you begin having severe allergic symptoms, such as difficulty breathing or swelling of your face, lips, or mouth. These symptoms can be life-threatening and need to be managed immediately.
Keep in mind: This risk isn’t unique to Ajovy. All medications, including other migraine medications, can cause allergic reactions. Thankfully, the risk is small overall.
3. Immune system reactions
Monoclonal antibody medications like Ajovy have the ability to trigger your immune system. This is because your body may view Ajovy as an unwelcome visitor. As a result, your immune system may step in to fight off the “offender.” Your body may go so far as to produce anti-drug antibodies as a way to defend itself. This can make Ajovy less effective.
During clinical studies, Ajovy caused these immune system reactions in a small number of people. But they don’t seem to happen very often. Side effects from these reactions are rare, too.
If you’re experiencing more migraines or feel like Ajovy isn’t working as well as it used to, reach out to your healthcare provider. You may need a different migraine medication.
Is there a way to treat or prevent injection site reactions?
Injection site reactions usually go away on their own after 1 to 2 days. In the meantime, there are ways to manage them.
Applying a warm compress for 15 to 20 minutes at the site of injection can help relieve pain. Alternating with an ice pack can help reduce swelling and warmth. When needed, you can consider turning to Tylenol (acetaminophen) or Advil (ibuprofen) to manage pain and swelling.
There are also several things you can do to reduce the odds of injection discomfort moving forward.
One way is to rotate the site of injection every time you administer the medication. Recommended Ajovy injection sites include the front of your thighs, your stomach, or the fleshy part of the upper back of the arms. Rotating these different injection sites gives your body time to heal between injections.
It’s also important to avoid injecting Ajovy into an area of the skin that’s irritated. Injecting a medication into an area that is inflamed due to a cut, a rash — or whatever it may be — increases your risk of developing an injection site reaction.
Applying a cold compress to the site 5 to 10 minutes before your injection also helps reduce swelling and pain. Allowing your medication to come to room temperature before you inject it can decrease pain during and after the injection, too.
Is Ajovy linked to any long-term side effects?
Ajovy hasn’t been around for all that long. So, what we know about long-term side effects is somewhat limited. However, according to a 2020 study, the answer appears to be no. Ajovy hasn’t been linked to any long-term side effects so far.
This study evaluated Ajovy’s safety and effectiveness in people using it for 1 year. Similar to results seen during clinical trials, the medication was well tolerated overall and wasn’t linked to any serious side effects.
During the study, injection site reactions were also found to be the most common side effect of Ajovy. Most of these reactions happened within 1 hour of administration and were mild to moderate in severity.
Is Ajovy better tolerated than other migraine medications?
Not really. All migraine prevention medications are fairly well tolerated.
Botox (onabotulinumtoxinA) was the first approved medication for this condition. Botox is generally well tolerated, but it can cause side effects like headache and neck pain. More serious side effects include trouble breathing, swelling, and allergic reactions. Botox also has to be administered by a healthcare professional for safety purposes.
Three other injectable CGRP antagonists are available for migraine prevention as well. These include Aimovig (erenumab), Emgality (galcanezumab), and Vyepti (eptinezumab). Similar to Ajovy, these medications are well tolerated with mild side effects. But all CGRP antagonists have the ability to cause allergic reactions, and each one has also been linked to other specific side effects.
Ajovy appears to have the highest incidence of injection site reactions compared with other CGRP agonists. On the other hand, Aimovig tends to cause more constipation, muscle cramps, and high blood pressure. And cold-like symptoms and infusion-related reactions tend to occur more with Vyepti. Unlike Ajovy, Aimovig, and Emgality, Vyepti is infused into a vein.
When should you contact a healthcare provider about Ajovy side effects?
Many of Ajovy’s side effects are mild and manageable. But, some side effects are more serious. Make sure to listen to your body. If you develop a fever or severe pain after giving yourself an Ajovy injection, contact your healthcare provider as soon as possible. If you have trouble breathing or your face, mouth, or tongue becomes swollen, call 911 or get emergency care right away — these are possible symptoms of a severe allergic reaction.
The bottom line
Injection site reactions are the most common Ajovy side effect. They’re usually mild and short lived, but pain relievers and warm compresses can help keep them at bay. Rashes, hives, and other symptoms of an allergic reaction can also occur with Ajovy, but they’re far less common. You should report any severe or unusual side effects to your healthcare provider right away.
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References
Cohen, J. M., et al. (2021). Immunogenicity of biologic therapies for migraine: A review of current evidence. The Journal of Headache and Pain.
Goadsby, P. J., et al. (2020). Long-term safety, tolerability, and efficacy of fremanezumab in migraine: A randomized study. Neurology.
Teva Pharmaceuticals USA, Inc. (2022). Ajovy- fremanezumab-vfrm injection [package insert].
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