Monitor Blood Pressure in Patients on Injectable CGRP Antagonists (Anti Migraine drug category)

You’ll hear concerns about using an injectable CGRP antagonist (Aimovig, etc) for migraine prevention in patients with CV risks.

Most data suggest that CGRP antagonists have minimal CV impact. But it’s mostly short-term and in young patients without CV risks.

Now a recent review of U.S. case reports suggests new-onset or worsening hypertension with Aimovig (erenumab).

So far, dozens of reports show a BP spike of about 40 mmHg systolic and 30 mmHg diastolic in Aimovig patients…even in some patients without CV risk factors.

The theory is that blocking the vasodilator CGRP may increase BP.

Point out that the risk of BP bumps is very rare with Aimovig. Explain that it can happen at any time…but seems most common within a week of the first or second dose.

There isn’t a safety signal yet with other injectable CGRP antagonists (Ajovy, etc), but Aimovig was first to market.

For now, lean away from any injectable CGRP antagonist in high-CV-risk patients, such as those with uncontrolled hypertension.

As a precaution, suggest baseline and regular BP checks for the first couple months for patients getting an injectable CGRP antagonist…and periodic home BP monitoring.

Tell patients to seek emergency medical care for symptoms such as chest pain, shortness of breath, or vision changes.