Key Takeaways
- Symbravo targets both early CGRP-mediated signaling and later prostaglandin-driven inflammation, offering a dual-mechanism approach that may help patients who have unmet needs with single-agent acute therapies.
- Counseling is critical—pharmacists should emphasize early use, limit dosing to prevent medication overuse headache, and screen for contraindications to both triptans and NSAIDs.
- Enhanced absorption via MoSEIC technology and non-substitutability with individual components make Symbravo a distinct option in the acute migraine toolkit, underscoring the pharmacist’s role in guiding safe, effective use.
In an interview for the Pharmacy Focus podcast with Pharmacy Times®, Shivang Joshi, MD, MPH, PRh, FAHS, director of Headache Medicine and Clinical Research at Community Neuroscience Services and assistant professor of neurology at UMass Chan Medical School, discusses the clinical rationale, practical considerations, and pharmacy implications of a fixed-dose combination of meloxicam and rizatriptan (Symbravo; Axsome Therapeutics) approved for acute migraine in adults.
Joshi outlines differences between prescribing the components separately versus using the fixed-dose tablet, emphasizing multi-mechanistic coverage, standardized dosing, and the product’s non-substitutability according to the package insert. He also explains key counseling points for pharmacists. These include early administration when possible, limiting use to no more than 2 to 3 days per week to avoid medication overuse headache, and assessing contraindications to non-steroidal anti-inflammatory drugs (NSAIDs) or triptans such as uncontrolled hypertension, cardiovascular disease, or a history of gastrointestinal ulcers.
Joshi underscores pharmacists' pivotal role in recognizing unmet needs, preventing medication overuse, guiding appropriate therapy, and connecting patients with credible educational resources or headache specialists when needed.
You can reach Shivang Joshi on LinkedIn here.
