Emgality (galcanezumab)

What is Emgality?

Emgality is a brand-name prescription medication that’s used in adults to:

• Prevent chronic and episodic migraines. According to the International Headache Society, people with chronic migraines have 15 or more migraine days per month. People with episodic migraines have fewer than 15 migraine days per month.
• Treat episodic cluster headaches. According to the International Headache Society, people with episodic cluster headaches have headaches that occur in clusters (close to each other in timing). The clusters last anywhere from one week to one year. They’re separated by at least three months of pain-free time.

Emgality comes as a prefilled pen or syringe that you’ll use to give yourself a monthly injection.

Emgality contains the drug galcanezumab, which is a monoclonal antibody. A monoclonal antibody is a type of drug developed from immune system cells in a lab. It blocks the activity of certain proteins in your body.

Effectiveness

Emgality has been found effective in clinical studies to prevent chronic and episodic migraines and to treat episodic cluster headaches.

Emgality may be an especially effective option for people who’ve been unable to reduce their number of cluster headaches or migraine days enough with other therapies. It may also be a good option for people who can’t take other medications to prevent migraines or treat cluster headaches because of drug interactions or difficult side effects.

For migraine prevention

In clinical studies of people with chronic migraines, 28% of people who took Emgality for 3 months cut in half their number of migraine days per month. In clinical studies of people with episodic migraines, about 60% of people who took Emgality for 6 months cut in half their number of migraine days per month.

For cluster headache treatment

In a clinical study, people with episodic cluster headaches were given either Emgality or a placebo (treatment with no active drug). After three weeks, people using Emgality had 8.7 fewer cluster headaches each week than they had before treatment. People taking the placebo had 5.2 fewer cluster headaches each week than they had prior to treatment.

A new kind of drug

Emgality belongs to a new class of drugs called calcitonin gene-related peptide (CGRP) antagonists. CGRP antagonists were designed specifically to prevent migraines. While Emgality is approved to treat cluster headaches and to prevent migraines, other CGRP antagonists are only approved for migraine prevention.

Emgality, which was approved in September 2018, was the third drug in this class approved by the Food and Drug Administration (FDA). The other FDA-approved CGRP antagonists are Aimovig, which was approved in May 2018, and Ajovy, which was approved in September 2018.

A fourth CGRP antagonist, called eptinezumab, is currently being studied and is expected to be approved soon.

Emgality generic

Emgality contains the drug galcanezumab. It only comes as a brand-name medication.

Emgality isn’t available in a generic form at this time.

Emgality side effects

Emgality can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking Emgality. This list does not include all possible side effects.

For more information on the possible side effects of Emgality, or tips on how to deal with a troubling side effect, talk with your doctor or pharmacist.

More common side effects

The most common side effects of Emgality are injection site reactions. This can include the following effects at the site where you inject the drug:

• redness
• itchiness
• pain
• tenderness

Injection site reactions are usually not severe or lasting. Most of the side effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Serious side effects from Emgality aren’t common, but they can occur. The primary serious side effect is a severe allergic reaction to Emgality. See below for details.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Emgality. It’s not known for sure how many people taking Emgality have an allergic reaction to the drug. Symptoms of a mild allergic reaction can include:

• skin rash
• itchiness
• flushing (skin warmth and redness, typically in your face or neck)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your tongue, mouth, or throat
• trouble breathing

Call your doctor right away if you have a severe allergic reaction to Emgality. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Side effect details

You may wonder how often certain side effects occur with this drug, or whether certain side effects pertain to it. Here’s some detail on some of the side effects this drug may or may not cause.

Fatigue

Fatigue (low energy) was not reported as a side effect in clinical studies of Emgality.

However, fatigue is commonly a symptom of migraines that people can experience before, during, or after a migraine. One clinical study of people with migraines found that those with more intense headaches were more likely to feel fatigue.

If fatigue is having a negative impact on your life, talk with your doctor about ways to improve your energy levels.

Long-term side effects

Emgality is a recently approved medication in a new class of drugs. As a result, there’s very little long-term research on Emgality’s safety. The longest clinical study of Emgality lasted one year, and people in the study did not report any serious side effects caused by Emgality.

Injection site reaction was the most common side effect reported in the year-long study. Other side effects reported included:

Emgality cost

As for all medications, prices for Emgality can vary. To find current prices for Emgality in your area, check out GoodRx.com.

The cost shown on GoodRx.com is what you may pay without insurance. Your actual cost will depend on your insurance coverage and the pharmacy you use.

Financial assistance

If you need financial support to pay for Emgality, help is available.

Eli Lilly and Company, the manufacturer of Emgality, offers a savings card that can help you pay less for Emgality. For more information and to find out if you’re eligible, call 833-364-2548 or visit the program website.

Emgality uses

The Food and Drug Administration (FDA) approves prescription drugs such as Emgality to treat or prevent certain conditions.

Emgality for migraines

Emgality is FDA-approved to prevent migraines in adults. It’s used to prevent both episodic and chronic migraines. Chronic migraines occur on 15 or more days per month, while episodic migraines occur on fewer than 15 days per month.

In clinical studies of people with chronic migraines, 28% of people who took Emgality for 3 months cut in half their number of migraine days per month. In clinical studies of people with episodic migraines, about 60% of people who took Emgality for 6 months cut in half their number of migraine days per month.

Emgality for cluster headaches

Emgality is FDA-approved to treat episodic cluster headaches in adults.

Cluster headaches are painful headaches that happen in clusters (several headaches in a short time period). This type of headache is very painful and can be episodic or chronic. Episodic cluster headaches have longer headache-free periods in between clusters than chronic cluster headaches do.

In a clinical study, people with episodic cluster headaches were given either Emgality or a placebo (treatment with no active drug). After three weeks, people using Emgality had 8.7 fewer cluster headaches each week than they had before treatment. People taking the placebo had 5.2 fewer cluster headaches each week than they had prior to treatment.

Uses that are not approved

Doctors may also prescribe drugs for other conditions that are not FDA-approved. This use is called off-label drug use.

Emgality for vestibular migraines

Emgality is not FDA-approved to treat or prevent vestibular migraines. Vestibular migraines are different from classic migraines in that they’re not painful most of the time. Instead, people with vestibular migraines will commonly feel vertigo or dizziness that lasts from seconds to hours.

It’s not known at this time if Emgality is effective at preventing or treating vestibular migraines. The drug is not being tested in clinical studies of people with vestibular migraines, but doctors may still choose to prescribe it off-label for this condition.

Alternatives to Emgality

Other drugs are available that can help prevent migraines and treat cluster headaches. Some may be better suited for you than others. If you’re interested in finding an alternative to Emgality, talk to your doctor to learn more about other medications that may work well for you.

Alternatives for migraine prevention

Examples of other drugs that are FDA-approved to prevent migraines include:

• certain seizure medications, such as divalproex sodium (Depakote) or topiramate (Topamax, Trokendi XR)
• the beta-blocker propranolol (Inderal, Inderal LA)
• the neurotoxin onabotulinumtoxinA (Botox)
• other calcitonin gene-related peptide (CGRP) antagonists: erenumab-aooe (Aimovig) and fremanezumab-vfrm (Ajovy)

Examples of other drugs that may be used off-label to prevent migraines include:

• certain antidepressants, such as amitriptyline or venlafaxine (Effexor XR)
• certain seizure medications, such as valproate sodium
• certain beta-blockers, such as metoprolol (Lopressor, Toprol XL) or atenolol (Tenormin)

Alternatives for cluster headache treatment

Sumatriptan (Imitrex) is FDA-approved to treat cluster headaches.

Other drugs are sometimes used off-label to treat cluster headaches. According to treatment guidelines, other options for treating cluster headaches include:

• zolmitriptan
• oxygen
• octreotide

CGRP antagonists

Emgality is a calcitonin gene-related peptide (CGRP) antagonist, which is a new type of drug. Emgality was approved by the FDA to prevent migraines in 2018. It was approved to treat episodic cluster headaches in 2019.

Two other CGRP antagonists are also approved to prevent migraines. These drugs are Aimovig and Ajovy. A fourth CGRP drug (eptinezumab) is expected to be approved soon.

How they work

The three available CGRP antagonists work in slightly different ways to prevent migraines or treat cluster headaches.

CGRP is a protein in your body that’s been linked with inflammation and vasodilation (widening of blood vessels) in the brain, which may cause the pain from headaches. To cause these effects, CGRP needs to bind (attach) to its receptors, which are molecules on the walls of cells in your brain.

Emgality and Ajovy work by binding to the CGRP, which prevents the CGRP from binding to its receptors. Aimovig, on the other hand, works by binding to the receptors themselves, which blocks the CGRP from doing the same.

By blocking CGRP from binding with its receptor, all three drugs help prevent inflammation and vasodilation, which can help prevent migraines or treat cluster headaches.

Side by side

The chart below compares general information about the three CGRP antagonists that are currently approved to prevent migraines or treat cluster headaches. For more information on how Emgality compares with these drugs, see the following section (“Emgality vs other drugs”).

	Aimovig	Ajovy	Emgality
Approval date for migraine prevention	May 17, 2018	September 14, 2018	September 27, 2018
Approval date for cluster headache treatment	Not approved	Not approved	June 4, 2019
Drug ingredient	Erenumab-aooe	Fremanezumab-vfrm	Galcanezumab-gnlm
How it’s administered	Subcutaneous self-injection using a prefilled autoinjector	Subcutaneous self-injection using a prefilled syringe	Subcutaneous self-injection using a prefilled pen or syringe
Dosing	Monthly	Monthly or every three months	Monthly
How it works	Prevents CGRP’s effects by blocking the CGRP receptor, which prevents CGRP from binding to it	Prevents CGRP’s effects by binding to CGRP, which prevents it from binding to the CGRP receptor	Prevents CGRP’s effects by binding to CGRP, which prevents it from binding to the CGRP receptor
Cost*	$575/month	$1,725/quarter $575/month	$575/month

*Prices can vary depending on your location, the pharmacy used, your insurance coverage, and manufacturer assistance programs.

Emgality vs. other drugs

You may wonder how Emgality compares to other medications that are prescribed for similar uses. Below are comparisons between Emgality and several medications.

Emgality vs. Aimovig

Emgality contains a monoclonal antibody called galcanezumab. Aimovig also contains a monoclonal antibody, which is called erenumab. A monoclonal antibody is a type of drug developed from immune system cells in a lab. It blocks the activity of certain proteins in your body.

While they do it in slightly different ways, Emgality and Aimovig both block the activity of a protein called calcitonin gene-related peptide (CGRP). CGRP causes inflammation and vasodilation (widening of blood vessels) in the brain, which may cause headaches. By blocking CGRP, these drugs help prevent these effects, which may help prevent migraines and treat cluster headaches.

Uses

Emgality and Aimovig are both FDA-approved to prevent migraines in adults. Emgality is also approved to treat episodic cluster headaches in adults.

Forms and administration

Emgality and Aimovig both come as an injection that’s given under your skin (subcutaneous) that you administer yourself at home.

Emgality comes as a single-dose prefilled pen, which gives a 120-mg injection. It also comes as single-dose prefilled syringes. These can give either a 100-mg or a 120-mg injection.

Aimovig comes as single-dose prefilled autoinjectors. These can give either a 70-mg or a 140-mg injection. Your doctor will decide the best dose for you.

After the first dose, which may be two or three injections, Emgality is injected once per month. Aimovig is injected monthly. Both drugs can be injected in your abdomen (belly), front of your thighs, or back of your upper arms. Emgality can also be injected in your buttocks.

Side effects and risks

Emgality and Aimovig both belong to the class of drugs called CGRP antagonists. They’re very similar drugs and cause similar common and serious side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Emgality, with Aimovig, or with both drugs (when taken individually).

• Can occur with Emgality:
• back pain
• respiratory tract infection
• sore throat
• sinus infection
• Can occur with Aimovig:
• Can occur with both Emgality and Aimovig:
• injection site reactions

Serious side effects

These lists contain examples of serious side effects that can occur with Emgality, with Aimovig, or with both drugs (when taken individually).

• Can occur with Emgality:
• few unique serious side effects
• Can occur with Aimovig:
• few unique serious side effects
• Can occur with both Emgality and Aimovig:
• serious allergic reaction

Immune reaction

In clinical trials of both Emgality and Aimovig, a small percentage of people had an immune reaction in which they developed antibodies against the drugs.

Antibodies are proteins in the immune system that fight foreign substances in your body as invaders. The body can make antibodies to any foreign substance, including monoclonal antibodies. If this happens with Emgality or Aimovig, the drug may no longer work for you.

In clinical studies of Emgality that lasted up to one year, 12.5 percent of people taking 120 mg per month of the drug developed antibodies to the drug.

In clinical studies of Aimovig that lasted 6 months, more than 6 percent of people taking 70 mg per month developed antibodies to the drug. And nearly 3 percent of people taking 140 mg per month of Aimovig developed antibodies.

However, because this drug was approved in 2018, it’s still too early to know how common this effect will be and how it might affect how people use these drugs.

Effectiveness

Emgality and Aimovig are both FDA-approved to prevent migraines, but they have not been directly compared in clinical studies. They’re both new medications, so they’re not yet included in treatment guidelines. However, they’re both effective for preventing migraines.

Episodic migraines

In clinical studies of Emgality, around 60 percent of people with episodic migraines who took the drug cut their number of migraine days at least in half over 6 months. Up to 16 percent were migraine-free over 6 months of treatment.

In clinical studies of Aimovig, about 40 percent of people with episodic migraines who received 70 mg of the drug cut their migraine days in half over 6 months of treatment. About 50 percent of people who received 140 mg saw similar results.

Chronic migraines

In clinical studies of Emgality, almost 30 percent of people with chronic migraines who took the drug for 3 months had half as many migraine days after treatment.

In a 3-month clinical study of Aimovig, about 40 percent of people with chronic migraines who received either 70 mg or 140 mg of the drug had half as many migraine days after treatment.

Costs

Emgality and Aimovig are both brand-name medications. There are currently no generic forms of either drug. Brand-name drugs usually cost more than generics.

While the manufacturer’s price is the same for both drugs, estimates from GoodRx.com indicate that Emgality may cost slightly less than Aimovig. The actual price you’ll pay for either drug will depend on your insurance plan, the pharmacy you use, and the dosage you’re taking.

Emgality vs. Ajovy

Emgality contains a monoclonal antibody called galcanezumab. Ajovy contains a monoclonal antibody called fremanezumab. A monoclonal antibody is a type of drug developed from immune system cells in a lab. It blocks the activity of certain proteins in your body.

Emgality and Ajovy both block the activity of a protein in your body called calcitonin gene-related peptide (CGRP). CGRP causes inflammation and vasodilation (widening of blood vessels) in the brain, which may cause headaches. By blocking CGRP, these drugs help prevent these effects, which may help prevent migraines and treat cluster headaches.

Uses

Emgality and Ajovy are both FDA-approved to prevent migraines in adults. Emgality is also approved to treat episodic cluster headaches in adults.

Forms and administration

Emgality comes as a single-dose prefilled syringe or pen. Ajovy comes as a single-dose prefilled syringe. Both drugs are given as an injection under the skin (subcutaneous) that you administer yourself at home.

For migraine prevention, Emgality is given as a single injection of 120 mg once per month. The first month you’re using Emgality to prevent migraines, you’ll take two injections at one time.

For cluster headache treatment, Emgality is given as three 100-mg injections (for a total of 300 mg of the drug) once a month.

Ajovy can be self-injected in two different schedules. It can be given as a single injection of 225 mg once per month, or as 3 separate injections (for a total of 675 mg) every 3 months. Your doctor will choose the right schedule for you.

Both drugs can be injected in your belly, front of your thighs, or back of your upper arms. Emgality can also be injected in your buttocks.

Side effects and risks

Emgality and Ajovy are very similar drugs and cause the same common and serious side effects.

More common side effects

More common side effects that can occur with both Emgality and Ajovy include injection site reactions. These reactions can cause symptoms such as redness, itchiness, and pain at the spot where you injected the medication. Injection site reactions are usually not severe.

People who took Emgality in clinical studies also reported:

• back pain
• respiratory tract infection
• sore throat
• sinus infection

Serious side effects

Serious side effects that can happen with both Emgality and Ajovy are not common, but they’re possible. Call your doctor right away if you’re concerned about your side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Emgality and Ajovy can both cause serious allergic reactions. These reactions are rare but can be severe. Symptoms of a serious allergic reaction include:

• swelling under the skin, typically in your eyelids, lips, hands, or feet
• swelling of your throat, mouth, and tongue
• trouble breathing

Immune reaction

In clinical trials for Emgality and Ajovy, a small percentage of people had an immune reaction in which their body developed antibodies against the drugs.

Antibodies are proteins in your immune system that fight foreign substances in your body as invaders. The body can make antibodies to any foreign substance, including monoclonal antibodies such as Emgality and Ajovy.

If your body develops antibodies to one of these drugs, it’s possible that the drug will no longer work for you.

In clinical studies that lasted up to one year, 12.5 percent of people taking 120 mg per month of Emgality developed antibodies to the drug. In clinical studies of Ajovy, less than 2 percent of people taking monthly or quarterly doses of Ajovy developed antibodies to the drug over 6 months.

However, as this drug was approved in 2018, it’s still too early to know how common this effect will be and how it might affect how people use these drugs.

Effectiveness

Emgality and Ajovy are both FDA-approved to prevent migraines, but they have not been directly compared in clinical studies. They’re both new medications, so they’re not yet included in treatment guidelines. However, they’re both effective for preventing migraines.

Episodic migraines

In a 6-month clinical study of Emgality, around 60 percent of people with episodic migraines reduced their number of migraine days by at least half with treatment. Up to 16 percent were migraine-free over 6 months of treatment.

In clinical studies of Ajovy, around 48 percent of people with episodic migraines who received monthly Ajovy treatment cut their migraine days in half over three months of treatment. About 44 percent of people who received Ajovy every 3 months had similar results.

Chronic migraines

In clinical studies of people with chronic migraines, almost 30 percent of people who took Emgality for 3 months had half as many migraine days with treatment.

In a 3-month clinical study of Ajovy, nearly 41 percent of people with chronic migraines who received monthly Ajovy had half as many migraine days after treatment. Around 37 percent of people who received Ajovy every 3 months had similar results.

Costs

Emgality and Ajovy are both brand-name medications. There are no generic forms of either drugs available at this time. Brand-name medications generally cost more than generics.

While the manufacturer’s price is the same for both drugs, estimates from GoodRx.com indicate that Emgality may cost less than Ajovy. The actual amount you’ll pay for either drug will depend on your insurance plan and the pharmacy you use.

Emgality vs. Botox

Emgality contains a monoclonal antibody called galcanezumab. A monoclonal antibody is a type of drug developed from immune system cells in a lab. Emgality works to prevent migraines and treat cluster headaches by blocking the activity of certain proteins that cause migraines.

Botox contains the drug onabotulinumtoxinA. It belongs to a class of drugs called neurotoxins. Botox temporarily paralyzes the muscles into which it’s injected. By paralyzing these muscles, Botox prevents pain signals from being activated. This is thought to prevent migraines before they start.

Uses

Emgality is FDA-approved to prevent chronic and episodic migraines and to treat episodic cluster headaches in adults.

Botox is approved to prevent chronic migraines (15 or more migraine days per month) in adults. Botox is also approved to treat several conditions, including:

Forms and administration

Emgality comes as a single-dose prefilled syringe or pen.

For migraine prevention, Emgality is given as a single injection of 120 mg once per month. The first month you’re using Emgality to prevent migraines, you’ll take two injections at one time.

For cluster headache treatment, Emgality is given as three 100-mg injections (for a total of 300 mg of the drug) once a month.

Emgality is injected under the skin (subcutaneous), and you give yourself the injection at home. It may be injected in your belly, the front of your thighs, the back of your upper arms, or your buttocks.

Botox is always given in a doctor’s office. It’s given as an injection into a muscle (intramuscular), typically every 12 weeks.

The usual sites for injection include your forehead, the back of your neck and shoulders, above and near your ears, and near your hairline at the base of your neck. For each appointment, your healthcare provider will typically give you 31 small injections across these areas.

Side effects and risks

Emgality and Botox are both used to prevent migraines, but they work in different ways in the body. Therefore, they have some of the same side effects, and some different.

More common side effects

These lists contain examples of more common side effects that can occur with Emgality, with Botox, or with both drugs (when taken individually).

• Can occur with Emgality:
• back pain
• respiratory tract infection
• sinus infection
• Can occur with Botox:
• flu-like symptoms
• headache or worsening migraine
• eyelid droop
• facial muscle paralysis
• neck pain
• muscle stiffness
• muscle pain and weakness
• Can occur with both Emgality and Botox:
• injection site reactions
• sore throat

Serious side effects

These lists contain examples of serious side effects that can occur with Emgality, with Botox, or with both drugs (when taken individually).

• Can occur with Emgality:
• few unique serious side effects
• Can occur with Botox:
• spread of paralysis to nearby muscles*
• trouble swallowing and breathing
• serious infection
• Can occur with both Emgality and Botox:
• serious allergic reactions

*Botox has a boxed warning from the FDA for spread of paralysis to nearby muscles following injection. A boxed warning is the strongest warning the FDA requires. It alerts doctors and patients about drug effects that may be dangerous.

Effectiveness

Both Emgality and Botox are used to prevent migraines. However, Botox is only used to prevent chronic migraines, while Emgality is used to prevent both episodic and chronic migraines.

The effectiveness of these drugs hasn’t been directly compared in clinical studies. However, both are effective at preventing chronic migraines.

In clinical studies of people with chronic migraines over 24 weeks, Botox reduced the number of migraine days by up to 9.2 days on average per month. In another study, around 48 percent of people decreased their number of migraine days by about half with Botox treatment.

In clinical studies of people with chronic migraines over 3 months, almost 30 percent of people who took Emgality had half as many migraine days.

Emgality is newly approved and is not yet included in treatment guidelines. Botox, which was approved in 2010, is recommended as a treatment option for people with chronic migraines by the American Academy of Neurology.

Costs

Emgality and Botox are both brand-name medications. There are no generic forms of either drug at this time.

According to estimates on GoodRx.com, Botox is typically less expensive than Emgality. However, the actual price you pay will depend on your insurance plan and the pharmacy you use.

Emgality vs. Topamax

Emgality contains the monoclonal antibody galcanezumab. A monoclonal antibody is a type of drug developed from immune system cells in a lab. Emgality works to prevent migraines and treat cluster headaches by blocking the activity of certain proteins that cause migraines.

Topamax contains the drug topiramate, a type of anti-epileptic drug. How it works in preventing migraines is not well understood. It’s believed to decrease overactive nerve cells in the brain that may cause migraines.

Uses

Both Emgality and Topamax are FDA-approved to prevent migraines. Emgality is approved for this use in adults, while Topamax is approved to prevent migraines in adults and children ages 12 and older.

Emgality is also approved to treat episodic cluster headaches in adults. Topamax is also approved to treat epilepsy.

Forms and administration

Emgality comes as a single-dose prefilled syringe or pen.

For migraine prevention, Emgality is given as a single injection of 120 mg once per month. The first month you’re using Emgality to prevent migraines, you’ll take two injections at one time.

For cluster headache treatment, Emgality is given as three 100-mg injections (for a total of 300 mg of the drug) once a month.

Emgality is injected under the skin (subcutaneous), and you give yourself the injection at home.

Topamax comes as a capsule or tablet. The usual dosage is 50 mg twice daily. However, your doctor will start you on a lower dose and increase to the usual dosage over several weeks.

Side effects and risks

Emgality and Topamax work in different ways in the body and therefore have different side effects. Some of the common and serious side effects of both drugs are listed below. This list does not include all possible side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Emgality, with Topamax, or with both drugs (when taken individually).

• Can occur with Emgality:
• back pain
• injection site reactions
• Can occur with Topamax:
• fatigue
• paresthesia (feeling of “pins and needles”)
• nausea
• diarrhea
• weight loss
• loss of appetite
• trouble concentrating
• Can occur with both Emgality and Topamax:
• respiratory tract infection
• sore throat
• sinus infection

Serious side effects

These lists contain examples of serious side effects that can occur with Emgality, with Topamax, or with both drugs (when taken individually).

• Can occur with Emgality:
• vision problems, including glaucoma
• decreased sweating (inability to regulate body temperature)
• metabolic acidosis
• mental effects such as confusion, memory problems, and depression
• suicidal thoughts and actions
• dependence on the drug
• encephalopathy (brain disease)
• kidney stones
• Can occur with Topamax:
• few unique serious side effects
• Can occur with both Emgality and Topamax:
• serious allergic reactions

Effectiveness

Both Emgality and Topamax are used for migraine prevention. The effectiveness of these drugs in preventing migraines hasn’t been directly compared in clinical studies. However, both drugs are effective at preventing migraines.

Episodic migraines

In clinical studies of people with episodic migraines over 26 weeks, people ages 12 years and older who took Topamax had about 2 fewer migraines per month. In a clinical study in children, participants aged 12 through 17 had 3 fewer migraines per month when taking the drug over 16 weeks.

In a 6-month clinical study of people with episodic migraines, around 60 percent of people cut their number of migraine days at least in half over 6 months of Emgality treatment. Up to 16 percent were migraine-free after 6 months of treatment.

Topiramate is recommended in treatment guidelines as an option for people with episodic migraines. Emgality is a newly-approved drug and has not yet been included in current guidelines.

Chronic migraines

Another study that pooled the results of several clinical trials found that Topamax reduced the number of migraines or other headaches by about five to nine per month, in people with chronic migraines.

In clinical studies of Emgality, almost 30 percent of people with chronic migraines had half as many migraine days with 3 months of treatment.

Costs

Emgality and Topamax are both brand-name medications. Emgality is not available in a generic form. Topamax does have a generic form, which is called topiramate.

Brand-name medications usually cost more than generic medications. According to estimates on GoodRx.com, Topamax may cost more than Emgality. However, the generic form of Topamax costs less than Emgality or Topamax.

Whichever drug or form you use, the actual price you pay will depend on your dosage, your insurance plan and the pharmacy you use.

Emgality dosage

The following information describes the dosage that’s commonly used or recommended. However, be sure to follow your doctor’s instructions.

Drug forms and strengths

Emgality comes in two forms: single-dose prefilled syringes and a single-dose prefilled pen. The prefilled pens contain 120 mg of galcanezumab per milliliter (mL) of solution. Prefilled syringes come in two strengths: 100 mg/mL and 120 mg/mL.

Each syringe and pen is made to be used once and then discarded.

Dosage for migraine prevention

For migraine prevention, either the prefilled pen or a prefilled syringe containing one 120-mg dose of Emgality is used. The typical dosage for Emgality is:

• First dose: Your first dose is called a loading dose. It will be 2 injections of 120 mg, given one after the other. Injecting two doses allows the drug to quickly reach an effective level in your body.
• All other doses: The second dose is given one month after the first. From the second dose on, you will take a single injection of 120 mg once per month.

Dosage for cluster headache treatment

For cluster headache treatment, a prefilled syringe containing one 100-mg dose of Emgality is used. The typical dosage for Emgality is:

• All doses: You’ll take 3 injections of 100 mg (for a total of 300 mg), given one after the other. Injecting three doses allows the drug to quickly reach an effective level in your body. You’ll take this dose once each month until your cluster headache period ends.

What if I miss a dose?

Take a dose as soon as you realize that you missed one. Your next dose should be a month after that one. Remember the new date so you can plan future doses accordingly.

Will I need to use this drug long-term?

If Emgality is effective at preventing migraines for you, you and your doctor may decide to continue treatment with Emgality long-term.

If Emgality is effective at treating your cluster headaches, you and your doctor may decide to continue treatment until your cluster headache period ends.

Emgality and alcohol

There is no interaction between Emgality and alcohol.

However, for some people, drinking alcohol while taking Emgality may seem to make the drug less effective. This is because alcohol is a migraine trigger for many people, and even small amounts of alcohol can cause a migraine for them. It’s also thought that alcohol can worsen headaches during cluster headache attacks.

If you find that alcohol causes more painful or more frequent migraines or headaches, you should avoid drinks that contain alcohol.

Emgality interactions

Many drugs can interact with other medications. Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

However, Emgality doesn’t generally have drug interactions. This is because of the way Emgality is processed in the body.

Many drugs, herbs, and supplements are metabolized (broken down) by enzymes in the liver. Monoclonal antibodies such as Emgality, on the other hand, are not generally metabolized in the liver. Instead, they’re broken down inside cells throughout the body.

Because Emgality isn’t broken down in the liver with other drugs, it generally doesn’t interact with them. But if you’re concerned about taking Emgality with other medications you may be using, talk to your doctor.

How to take Emgality

Emgality is taken as an injection under your skin (subcutaneous) once each month. When you first get your prescription for Emgality, your healthcare provider will explain how to inject the medication yourself.

The first time you inject Emgality, you may do it at your doctor’s office or at your home. Either way, you’ll give yourself two or three separate injections. After that, you’ll give yourself one injection at home each month to prevent migraines. You’ll give yourself three injections each month to treat cluster headaches.

Emgality comes in two forms: single-dose prefilled syringes and a single-dose prefilled pen. Both forms contain only one dose and are meant to be used once and then discarded. Your doctor will discuss with you whether the pen or syringe is right for you.

For information on how to use both the syringe and the pen, visit the manufacturer’s website. There you’ll be able to see an instructional video and images of injection instructions.

Note: Remember that for your very first dose, you’ll need either two syringes or pens, or three syringes.

Timing

Emgality should be taken once every month. It can be taken at any time of day.

If you miss a dose, take Emgality as soon as you remember. The next dose should be taken one month after you take that one. A medication reminder tool can help you remember to take Emgality on schedule.

Taking Emgality with food

Emgality can be taken with or without food.

How Emgality works

Emgality is a monoclonal antibody, which is a special immune system protein created in a lab. Emgality works by blocking the activity of the calcitonin gene-related peptide (CGRP) protein in your body. CGRP is involved in inflammation and vasodilation (widening of blood vessels) in your brain.

CGRP is thought to play an important role in causing headaches. In fact, people who are starting to get a migraine or cluster headache have high levels of CGRP in their blood. By blocking the activity of CGRP, Emgality helps prevent a migraines from starting and treats cluster headaches.

While most drugs target (act on) multiple chemicals or parts of cells in your body, monoclonal antibodies such as Emgality only target one substance in the body. As a result, Emgality has fewer side effects and drug interactions. This may make it a good option for people who can’t tolerate other medications.

It may also be a good option for people who have tried other medications that didn’t help reduce their migraine days or cluster headaches enough.

How long does it take to work?

It may take one week to several weeks for you to notice any changes in your headache pattern caused by Emgality. And it may take several months for Emgality to take full effect.

In clinical studies, many people who took Emgality had fewer migraine days within one month of their first dose. The number of migraine days continued to decrease over several months. For those with cluster headaches, many people had fewer cluster headache attacks within the first week of treatment.

Emgality and pregnancy

There aren’t enough studies to know if Emgality is safe to take during pregnancy. Animal studies showed no harm to a pregnancy when the mother received Emgality. However, animal studies do not always predict whether drugs will be safe in humans.

If you’re pregnant or considering becoming pregnant, talk with your doctor to see if Emgality is right for you. You may need to wait until you’re no longer pregnant to use Emgality.

Emgality and breastfeeding

It’s not known if Emgality passes into breast milk.

If you’re breastfeeding your child or would like to, your doctor will talk with you about the risks and benefits of breastfeeding while taking Emgality. You may need to stop breastfeeding if you begin taking Emgality.

Common questions about Emgality

Here are answers to some frequently asked questions about Emgality.

Is Emgality a triptan?

No, Emgality is not a triptan. Triptans, such as sumatriptan (Imitrex), are a class of medications that are used to treat migraines or cluster headaches when they occur. Emgality is used to prevent migraines from happening. Emgality and triptans work in different ways to affect migraines or cluster headaches.

Is Emgality the same as Aimovig?

No. Emgality (galcanezumab) and Aimovig (erenumab) are both medications used to prevent migraines, and they both belong to a new class of drugs called calcitonin gene-related peptide (CGRP) antagonists. However, Emgality is also approved to treat cluster headaches. These drugs work in slightly different ways in your body.

CGRP is a protein in your body that’s been linked with inflammation and vasodilation (widening of blood vessels) in the brain. To cause these effects, CGRP needs to bind (attach) to its receptors, which are molecules on the walls of cells in your brain.

Emgality works by binding to the receptors itself, which blocks CGRP from doing the same. Aimovig, on the other hand, binds to CGRP, which also prevents CGRP from binding to the receptors.

So both drugs block CGRP from binding to its receptors, but they do it in slightly different ways. Your doctor will determine which medication is right for you.

How is Emgality different from other migraine drugs?

Emgality is different from most other migraine drugs because it’s one of the first drugs developed specifically to prevent migraines. It belongs to a new class of drugs called calcitonin gene-related peptide (CGRP) antagonists.

Most other drugs used to prevent migraines were initially developed for different purposes, such as treating depression, seizures, or high blood pressure. Many are used off-label to prevent migraines.

Emgality is also different from most other migraine drugs because it’s injected once per month. Most other medications used to prevent migraines are tablets or pills that need to be taken daily. Botox, one alternative drug, is an injection, but it’s given once every three months in a doctor’s office. Emgality is given as a self-injection in your home.

In addition, Emgality is a monoclonal antibody. This is a type of drug developed from immune system cells in a lab. These drugs are not broken down by the liver, as most other migraine prevention drugs are. As a result, Emgality and other monoclonal antibodies have fewer drug interactions than other drugs that prevent migraines.

Does Emgality cure migraines?

No, Emgality does not cure migraines. There are no medications available at this time that can cure migraines.

If I take Emgality, can I stop taking my other preventive medications?

Every person’s response to Emgality will be unique. Some people may be able to stop taking their other preventive medications, while others may not. For instance, if you have more frequent migraines or cluster headaches, Emgality may be best used as an addition to the medications you already take.

Emgality overdose

Injecting multiple doses of Emgality can increase your risk of injection site reactions. If you’re hypersensitive or allergic to Emgality, you may also be at risk of having a more severe reaction.

Symptoms of overdose or reaction from multiple injections

Symptoms of an overdose or a severe reaction from multiple injections can include:

• severe pain, redness, or itchiness in the area near the injection
• flushing
• hives
• angioedema (swelling under your skin, typically in your eyelids, lips, hands, or feet)
• swelling of your throat, mouth, or tongue
• trouble breathing

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

Emgality precautions

Before taking Emgality, talk with your doctor about your health history. Emgality may not be right for you if you have the following medical history:

• History of serious hypersensitivity reaction to Emgality. Emgality should not be used in people who’ve had a serious hypersensitivity reaction to Emgality in the past. A serious reaction involves a rash, itchy skin, and trouble breathing. This can occur hours to days after taking a dose.
• Pregnancy. Talk with your doctor if you’re pregnant or may become pregnant while using Emgality. It’s not known if this drug is safe to take during pregnancy.

Emgality expiration, storage and disposal

When Emgality is dispensed from the pharmacy, the pharmacist will add an expiration date to the label on the package. This date is typically one year from the date the medication was dispensed.

The expiration date helps guarantee the effectiveness of the medication during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains effective can depend on many factors, including how and where the medication is stored.

Emgality should be stored in the refrigerator, at a temperature between 36⁰F and 46⁰F (2⁰C and 8⁰C). It should not be frozen. Emgality can be stored at room temperature (up to 86⁰F) for as long as 7 days. Once it has been removed from the refrigerator, don’t put it back in the refrigerator.

Disposal

After taking your injections, you’ll need to safely dispose of the needles you used. The manufacturer of Emgality has a program which can provide you with free sharps disposal containers. To find out more about this program, visit the manufacturer’s website or call 833-364-2548.

If you no longer need to take Emgality and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

The FDA website provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.

Professional information for Emgality

The following information is provided for clinicians and other healthcare professionals.

Indications

Emgality is approved for use in adults for:

• prevention of migraines
• treatment of episodic cluster headaches

Mechanism of action

Emgality (galcanezumab) is a humanized monoclonal antibody that blocks calcitonin gene-related peptide (CGRP) from binding to its receptor.

Pharmacokinetics and metabolism

Emgality is administered as a loading dose (2 injections of 120 mg each) to reach steady-state concentration after the first dose for migraine prevention.

There is no loading dose for treatment of cluster headaches. Steady-state concentration of Emgality when used to treat cluster headaches is reached after four doses (one dose each month for four months).

Maximum concentration is achieved in five days. The injection site location does not affect absorption.

Emgality is degraded to small peptides and amino acids via catabolism. It’s not metabolized by cytochrome P450 enzymes. Elimination half-life is approximately 27 days.

Contraindications

Emgality is contraindicated in people with a history of serious hypersensitivity to galcanezumab or any of the drug’s excipients.

Storage

Emgality should be stored in the refrigerator (36⁰F/2⁰C to 46⁰F/8⁰C). Emgality’s shelf life is two years if maintained in the refrigerator. It can be stored at room temperature (up to 86⁰F/30⁰C) for up to 7 days. Once removed from the refrigerator, it cannot be placed back into the refrigerator. It should not be frozen.

Protect Emgality from light once it’s taken out of its packaging. Do not shake Emgality products.

Disclaimer: MedicalNewsToday has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.