Ubrelvy Drug Interactions: What to Avoid and What to Tell Your Doctor

Ubrelvy (ubrogepant) has a well-defined set of drug interactions that every patient — and every provider — needs to know. Some interactions can raise Ubrelvy levels in your body to unsafe heights, while others can make it nearly ineffective. A few are contraindicated entirely.

Here is a complete, organized guide to Ubrelvy drug interactions — including common medications you may not realize are affected.

Why Does Ubrelvy Have Drug Interactions?

Ubrelvy is primarily metabolized (broken down) by the CYP3A4 enzyme in the liver. It is also a substrate of drug transport proteins called P-glycoprotein (P-gp) and BCRP, which help move it in and out of cells.

Any drug that significantly affects CYP3A4, P-gp, or BCRP activity can change how much Ubrelvy accumulates in your body. Too much Ubrelvy = elevated risk of side effects. Too little Ubrelvy = reduced effectiveness for your migraine.

CONTRAINDICATED: Drugs You Must NOT Take With Ubrelvy

These combinations are contraindicated — meaning you should not take Ubrelvy at all while using these medications:

Strong CYP3A4 Inhibitors

These medications block CYP3A4 so strongly that taking Ubrelvy with them can increase ubrogepant blood levels up to 9.7-fold — dramatically raising the risk of side effects:

Ketoconazole (antifungal)

Itraconazole (antifungal)

Clarithromycin (antibiotic — commonly used for respiratory infections)

Nirmatrelvir/ritonavir (Paxlovid) — the COVID-19 antiviral treatment. If you are prescribed Paxlovid, tell your prescriber you take Ubrelvy immediately. This combination is contraindicated.

Atazanavir, cobicistat, conivaptan, ceritinib, idelalisib — used for HIV, cancer, and other conditions

Dose Adjustment Required: Moderate CYP3A4 Inhibitors

With these medications, you can still take Ubrelvy, but your dose must be reduced to a maximum of 50 mg per day (not 100 mg):

Verapamil (heart/blood pressure medication) — increases ubrogepant exposure ~3.5-fold

Diltiazem (heart medication)

Erythromycin (antibiotic)

Fluconazole (antifungal — Diflucan, commonly prescribed for yeast infections)

P-gp and BCRP Inhibitors: Dose Reduction

These drugs block the transport proteins that move Ubrelvy out of cells, raising Ubrelvy levels. Dose reduction is recommended:

Quinidine (antiarrhythmic)

Carvedilol (beta-blocker used for heart failure)

Amiodarone (antiarrhythmic)

Eltrombopag (used for low platelet count)

Drugs That Make Ubrelvy LESS Effective: CYP3A4 Inducers

These drugs accelerate CYP3A4 activity, causing Ubrelvy to be broken down faster, reducing how much is in your system:

Rifampin (antibiotic for tuberculosis) — reduces Ubrelvy exposure by ~80%. Avoid or use alternative.

Phenytoin (Dilantin) (seizure medication)

Phenobarbital, Pentobarbital (barbiturates)

Carbamazepine (Tegretol) (seizure/mood medication)

Topiramate (Topamax) — note: sometimes used for migraine prevention; discuss with your doctor if you take both

Food Interaction: Grapefruit

Grapefruit and grapefruit juice contain compounds that inhibit CYP3A4. If you consume grapefruit, a dosage modification is recommended. You should not take a second Ubrelvy tablet within 24 hours after consuming grapefruit or grapefruit juice. Talk to your doctor about this if grapefruit is part of your regular diet.

Herbal Interaction: St. John's Wort

St. John's Wort is a CYP3A4 inducer. Regular use can reduce Ubrelvy's effectiveness. If you take St. John's Wort supplements, tell your doctor — it may interfere with your migraine treatment.

No Significant Interaction With:

Clinical studies showed no significant pharmacokinetic interaction between Ubrelvy and:

Sumatriptan (another migraine medication)

Naproxen (an NSAID pain reliever)

Acetaminophen (Tylenol)

Oral contraceptives (estrogen/progesterone-containing)

Esomeprazole (Nexium, a proton pump inhibitor)

What to Tell Your Doctor

Before starting Ubrelvy, give your doctor a complete list of all your medications, including prescription drugs, over-the-counter medications, vitamins, and herbal products. Pay special attention to:

Any antifungals (for toenail fungus, yeast infections, etc.)

Heart or blood pressure medications (especially calcium channel blockers like verapamil or diltiazem)

Antibiotics — especially clarithromycin or erythromycin

Anticonvulsants or seizure medications

HIV or antiretroviral medications

Paxlovid or other COVID-19 antivirals

Herbal supplements including St. John's Wort

For more on Ubrelvy safety, see our guide on Ubrelvy side effects: what to expect and when to call your doctor. And if you need help finding Ubrelvy in stock at a nearby pharmacy, visit medfinder.