Key takeaways:
Ubrelvy (ubrogepant) is a prescription migraine medication that can interact with several antibiotics, heart medications, and ritonavir-containing products — such as Paxlovid. Interactions like these raise the risk of experiencing Ubrelvy side effects.
Other interactions can make Ubrelvy less effective. Keep an eye out for antiseizure medications such as phenytoin (Dilantin, Phenytek), barbiturates such as phenobarbital, and St. John’s wort.
It’s tough to manage Ubrelvy’s interactions on your own. To stay safe, always let your healthcare team know about all the medications and supplements you take. This helps them manage and prevent interactions proactively.
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If you rely on Ubrelvy (ubrogepant) to treat migraines, you know how effective it can be at providing relief. And if you’re just starting it, you’ll likely soon notice how fast it can help.
But, as with any medication, it’s good to be aware of the potential risks with Ubrelvy. This includes Ubrelvy interactions. Several medications and foods increase the risk of side effects from this oral tablet, while others can make it less effective.
Ubrelvy interactions at a glance
Notable medications and foods that increase the risk of Ubrelvy side effects include:
Antibiotics, such as clarithromycin (Biaxin XL)
Antifungals, such as ketoconazole
Ritonavir (Norvir) and ritonavir-containing combination products, such as Paxlovid
Verapamil (Verelan)
Diltiazem (Cardizem)
Quinidine
Carvedilol (Coreg)
Amiodarone (Pacerone)
Cyclosporine (Sandimmune, Gengraf, Neoral)
Eltrombopag (Promacta)
Febuxostat (Uloric)
Grapefruit
These medications and supplements can make Ubrelvy less effective:
Rifampin (Rifadin), a different antibiotic
Antiseizure medications, such as phenytoin (Dilantin, Phenytek) and carbamazepine (Tegretol)
Barbiturates, such as phenobarbital and primidone (Mysoline)
Modafinil (Provigil)
St. John’s wort
Here, we’ll dive deeper into seven Ubrelvy interactions and how to manage them. Knowing about these interactions can help you make safer choices while pairing Ubrelvy with other medications.
Keep in mind: This list isn’t all-inclusive. Make sure your healthcare team is aware of everything you’re taking. This includes prescription medications, over-the-counter products, and dietary supplements. They can analyze this information and help you avoid interactions.
Why Ubrelvy interactions happen
Ubrelvy can interact with other medications because it’s processed in your liver by an enzyme (protein) called CYP3A4. Some medications speed up or slow down this enzyme, which can affect how much Ubrelvy is in your body. If too much medication builds up, you may have a higher risk of side effects. If there’s too little, the medication might not work as well.
Ubrelvy is also affected by proteins in your body called P-gp and BCRP. These proteins help move medications in and out of cells. If another drug blocks them, it could cause more Ubrelvy to stay in your system, again raising the chance of side effects.
1. Certain antibiotics and antifungals
Several antibiotics — such as clarithromycin, erythromycin (Ery-Tab), and ciprofloxacin (Cipro) — can slow the enzyme that breaks down Ubrelvy. This means there’s a higher chance of experiencing side effects. Common Ubrelvy side effects are nausea, fatigue, and dry mouth. Azole antifungals — namely ketoconazole, itraconazole (Sporanox), and fluconazole (Diflucan) — affect Ubrelvy in a similar way.
On the other hand, antibiotics such as rifampin and rifabutin (Mycobutin) speed up this process, which can make Ubrelvy less effective at treating migraines.
To stay safe, let your prescriber and pharmacist know if you take Ubrelvy and are starting a new antibiotic or antifungal. They may need to prescribe a different medication — especially if it’s one that “strongly” interacts with Ubrelvy, such as clarithromycin, ketoconazole, or rifampin.
If the interaction is milder, as with fluconazole, a simple dose change may be sufficient.
Calcitonin gene-related peptide (CGRP) antagonists: Learn how Ubrelvy (ubrogepant) stacks up to other CGRP inhibitors for migraine management.
Ubrelvy FAQs: Pharmacists describe how long Ubrelvy takes to work, what can affect its onset time, and more.
Outdated migraine medications: No, Ubrelvy isn’t outdated. But other migraine medications you’re taking might be.
Good to know: These interactions usually only apply to the oral and injectable forms of these medications. Topical products, such as erythromycin eye ointment and ketoconazole cream, aren’t likely to cause problems.
2. Products that contain ritonavir, including Paxlovid
Ritonavir is an antiviral medication that’s most often used to treat HIV. It’s also part of the COVID-19 medication Paxlovid (nirmatrelvir / ritonavir).
Ritonavir is a very strong blocker of the enzyme that breaks down Ubrelvy. Taking Ubrelvy with ritonavir (or Paxlovid) can cause Ubrelvy to build up to unsafe levels, increasing the risk of side effects.
If you’re asked to take Paxlovid or another ritonavir-containing medication, be sure to tell your prescriber that you take Ubrelvy. They’ll likely recommend avoiding the combination. A prescription for an alternative migraine, HIV, or COVID medication would be a safer bet, depending on the situation.
3. Several heart medications
Some heart medications don't mix well with Ubrelvy. Some of the more common offenders are verapamil, diltiazem, and carvedilol. They all slow down how your body processes Ubrelvy. This, again, increases the risk of Ubrelvy side effects. Amiodarone and quinidine have similar effects.
You may not need to avoid these medications altogether while taking Ubrelvy. But if you do take any of these heart medications, your cardiologist or neurologist may suggest starting with a lower dose of Ubrelvy and/or waiting longer between doses.
Everyone’s heart health and migraines are unique, so always follow your healthcare team’s dosage instructions carefully to avoid problems.
4. Grapefruit
Grapefruit and grapefruit juice are notorious for causing interactions, and Ubrelvy is one of them. Grapefruit blocks the enzyme that breaks down Ubrelvy, which can lead to higher levels of the medication in your body and a greater risk of side effects.
To be safe, it’s best to avoid grapefruit and grapefruit juice while taking Ubrelvy. This is especially true if you enjoy large amounts of grapefruit or consume it routinely. But if you only drink it occasionally, your prescriber may tell you to just take a lower dose of Ubrelvy (or take it less often). Be honest about your grapefruit habits so they can guide you safely.
5. Antiseizure medications
Several antiseizure medications, especially phenytoin and carbamazepine (Tegretol), speed up the enzyme that breaks down Ubrelvy. This means Ubrelvy leaves your body faster and likely won’t work as well to treat migraines.
If you take any antiseizure medications, it’s important to talk with your neurologist before starting Ubrelvy. In many cases, it’s best to avoid adding Ubrelvy to the mix. Your neurologist may recommend a different migraine treatment to help you find better (and safer) relief.
Never stop or change your antiseizure regimen on your own, either. The best way to treat epilepsy is very personalized, and taking Ubrelvy could cause serious problems.
6. Barbiturates
Barbiturates, which include medications such as phenobarbital and primidone (Mysoline), also make your body clear Ubrelvy more quickly. This can reduce how well Ubrelvy works for your migraines. Barbiturates treat insomnia and seizures.
Barbiturates are a no-go with Ubrelvy. Try to avoid combining them. However, make sure to loop in your neurologist if you really need one. They can help you decide if Ubrelvy is right for you or if another migraine treatment would be better.
7. St. John’s wort
St. John’s wort is a popular herbal supplement that’s marketed for mood and depression. But it can cause your body to break down Ubrelvy faster, making it less effective.
Avoid taking St. John’s wort with Ubrelvy. Many prescription antidepressants are available that don’t interact with Ubrelvy. A healthcare professional can recommend a specific antidepressant that may be helpful for you, depending on your symptoms, medical history, and personal preferences.
The bottom line
Ubrelvy (ubrogepant) is a helpful tool for managing migraines. But some medicines, supplements, and even foods can worsen its side effects or make it less effective. Common Ubrelvy interactions include antibiotics and antifungals, ritonavir-containing products such as Paxlovid, and heart medications.
It’s hard to avoid Ubrelvy interactions on your own. Managing interactions can also vary depending on the situation. So, the best way to stay safe is to always tell your healthcare team about everything you take. This includes prescriptions, over-the-counter medications, and dietary supplements. That way, they can help you avoid problems and get the most out of your migraine treatment.
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References
Ailani, J., et al. (2021). The American Headache Society consensus statement: Update on integrating new migraine treatments into clinical practice. Headache: The Journal of Head and Face Pain.
Allergan. (2025). Ubrelvy- ubrogepant tablet [package insert]. DailyMed.
American Heart Association. (2024). Medication interactions: Food, supplements and other drugs.
UpToDate. (n.d.). Cytochrome P450 3A (including 3A4) inhibitors and inducers.
U.S. Food and Drug Administration. (2025). For healthcare professionals | FDA’s examples of drugs that interact with CYP enzymes and transporter systems.
