Nurtec ODT vs. Reyvow For Migraines: 6 Differences You Should Know About

With the introduction of new medications, migraine treatment has been revolutionized in recent years. Traditionally, triptans were the go-to medications for treating migraines. But they have limitations and aren’t safe for everyone. This is where newer medications may be helpful.

Here, we'll cover six differences between Nurtec ODT (rimegepant) versus Reyvow (lasmiditan), two migraine medications that work in unique ways.

1. They work differently to treat migraines

Nurtec ODT and Reyvow work differently to treat migraines. For starters, they’re in different medication classes. Nurtec ODT is a calcitonin gene-related peptide (CGRP) antagonist. And Reyvow is a serotonin (5-HT) 1F receptor agonist.

Nurtec ODT works by blocking the actions of a protein called calcitonin gene-related peptide (CGRP). CGRP plays a role in many processes in the body. It’s involved in pain, blood flow, and inflammation. And when you experience a migraine, it’s released in excess. By blocking CGRP, Nurtec ODT can prevent or improve pain and inflammation caused by migraines.

Exactly how Reyvow works isn’t fully understood. It binds to a specific type of serotonin receptor (binding site) in your brain. This boosts the effects of serotonin. But this probably isn’t the main way that Reyvow treats migraines. Reyvow also decreases the amount of CGRP released in the body, blocking pain and inflammation during a migraine attack.

Good to know: Triptans also bind to serotonin receptors. But they’re different from the serotonin receptors that Reyvow binds to. Examples of triptans include sumatriptan (Imitrex) and rizatriptan (Maxalt, Maxalt-MLT).

2. Nurtec ODT can also be used to prevent migraines

A major difference between Nurtec ODT and Reyvow is that Nurtec ODT can also prevent migraines. Reyvow isn’t approved for this reason; it’s only approved to treat migraines.

When used to prevent migraines, Nurtec ODT should be taken every other day. Though, it's not typically a first-choice medication for migraine prevention.

When used to treat migraines, both Nurtec ODT and Reyvow should be taken soon after your migraine has started. For migraine treatment, only one dose of these medications should be used in a 24-hour period.

In general, Nurtec ODT and Reyvow aren’t considered first-choice treatments for migraine attacks. They’re usually used if triptans don’t work or aren’t a good treatment option for you.

Good to know: Using more than 18 doses of Nurtec ODT in 30 days, or using Reyvow more than 4 times a month, hasn’t been studied. So keep your prescriber informed about how often you’re using your migraine medication. If you’re needing it more often than recommended, you may need a change in your migraine treatment plan.

3. They come in different oral tablet forms

Nurtect ODT and Reyvow are oral medications. But Nurtec ODT comes as an orally dissolving tablet (which accounts for the “ODT” in Nurtec ODT). Reyvow comes as a traditional oral tablet.

Nurtec ODT isn’t meant to be swallowed. Instead, you’ll place the tablet on or underneath your tongue. You’ll let the tablet dissolve, which releases the medication into your system. So it may be a good option for people who have trouble swallowing pills. It’s important that you handle Nurtec ODT with dry hands so that the tablet doesn’t start dissolving when it comes into contact with your skin.

On the other hand, Reyvow tablets should be swallowed whole. Don’t crush, split, or chew the tablets.

You can take both medications with or without food. But you shouldn’t have food in your mouth while waiting for Nurtec ODT to dissolve. This could lead to accidentally swallowing the ODT tablet.

4. Reyvow is a controlled substance with restrictions on how it’s prescribed

Controlled substances are medications and substances that can cause physical and mental dependence. They can also be misused.

Controlled substances are classified into groups called “schedules.” Reyvow is a “Schedule 5” controlled substance. Among all controlled substances, Schedule 5 substances have the lowest risk for dependence and misuse. In comparison, Schedule 1 substances have the highest risk.

Some states may restrict how often you can get a refill for a Schedule 5 medication before requiring a new prescription from your healthcare provider. So this may impact how you refill Reyvow.

Nurtec ODT isn’t a controlled substance. It’s not known to have a risk for dependence or misuse, and there aren’t specific restrictions on prescribing it.

5. They have different drug interactions

Nurtec ODT and Reyvow have different drug interactions. A drug interaction can occur when one medication affects how another medication works in your body. Interactions can raise your risk for side effects or make a medication less effective.

Below are some key drug interactions of Nurtec ODT and Reyvow. They don’t share many of the same interactions, so this may help your prescriber decide which medication is best for you. Keep in mind, this isn’t a complete list of possible interactions.

6. Nurtec ODT and Reyvow have different side effects

Another key difference between Nurtec ODT and Reyvow is that they have different side effects.

More common side effects

Nurtec ODT is well-tolerated, but some people have gastrointestinal side effects. These include nausea, stomach pain, and upset stomach. Taking it with food may help.

Reyvow’s most common side effects are dizziness and tiredness. This is due to its effect on the brain. A numbness or tingling sensation, and nausea and vomiting can also occur.

Serious side effects

The only known serious risk associated with Nurtec ODT is a rare allergic reaction. This may include trouble breathing and a severe rash. If you experience either of these symptoms, stop taking Nurtec ODT and seek emergency care.

Reyvow may also cause an allergic reaction, though this is rare. It also has a few other rare but serious side effects, including:

• Severe sleepiness, dizziness, and lack of alertness: This could affect your ability to drive. You shouldn’t drive, or do other activities that require alertness, for at least 8 hours after taking Reyvow.

• Serotonin syndrome: Since Reyvow increases serotonin levels in your body, a condition called serotonin syndrome can occur if you take Reyvow with other medications that increase serotonin. While serotonin syndrome is usually mild, severe symptoms include heavy sweating, high fever, and a fast heart rate. Seek emergency care if these symptoms occur.

• Medication overuse headache: Using migraine treatment medications for 10 or more days out of any 30-day period can worsen migraines. But for Reyvow, the safety of taking more than 4 doses per month hasn’t been studied. Let your prescriber know if you’re needing more frequent migraine treatment than recommended.

Good to know: It’s not known whether Nurtec ODT and Reyvow are safe during pregnancy. Discuss with your prescriber if you’re planning to become pregnant or become pregnant during treatment with either medication.

How do you and your prescriber decide between Nurtec ODT and Reyvow?

First, it’s important to know that Nurtec ODT and Reyvow aren’t typically first-choice medications for migraine. Your prescriber might consider these two as options depending on how severe your migraine is, whether you’ve tried other medications, and whether there’s a reason you can’t take first-choice medications, such as triptans.

Deciding between Nurtec ODT and Reyvow comes down to a few factors. First, you and your prescriber will determine if you would benefit from migraine treatment or prevention. Since Reyvow isn’t approved for migraine prevention, Nurtec ODT would be a better choice if you need preventative treatment.

For migraine treatment, you and your prescriber will consider various factors, including: 

• The different Nurtec ODT and Reyvow drug interactions 

• Whether you have an increased risk of side effects from Nurtec ODT or Reyvow

• Other medical conditions you may have

• Whether you’re able to avoid driving for at least 8 hours after taking Reyvow

• Whether you have difficulty swallowing tablets (Nurtec ODT isn’t swallowed, so it may be a better option)

How to save on Nurtec ODT and Reyvow

Nurtec ODT and Reyvow are only available as brand-name medications. With savings cards from the manufacturers, you may be able to receive Nurtec ODT and Reyvow for free if you’re eligible.

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Written by:

Alex Brewer, PharmD, MBA

Alex Brewer, PharmD, MBA, is a licensed pharmacist specializing in chronic disease and health and wellness. Upon completing his residency, he worked in the managed care field, conducting medication therapy management and adherence counseling sessions with Medicaid, Medicare, and private insurance patients, before transitioning to a career in medical writing.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Daphne Berryhill, RPh

Daphne Berryhill, RPh, has two decades of experience as a clinical pharmacist. She spent most of her career in the Chicago area practicing in-home infusion.

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