Metabolic and toxicological considerations regarding CGRP mAbs and CGRP antagonists to treat migraine in Covid-19 patients: a narrative review.

Clinicians should be careful about using gepants for Covid-19 patients, due to the potential drug interactions with drugs metabolized via CYP3A4 cytochrome. In particular, Covid-19 treatment (especially nirmatrelvir packaged with ritonavir, as Paxlovid) should be considered cautiously. It is advisable to stop or adjust the dose (10 mg atogepant when used for episodic migraine) of gepants when using Paxlovid (except for zavegepant). CGRP moncolconal antibodies (CGRP-mAbs) do not have drug - drug interactions, but a few days' interval between a Covid-19 vaccination and the use of CGRP mAbs is recommended to allow the accurate identification of the possible adverse effects, such as injection site reaction. Covid-19- and vaccination-related headache are known to occur. Whether CGRP-related drugs would be of benefit in these circumstances is not yet known.