What Is Zavzpret (Zavegepant)?
Zavzpret is a calcitonin gene-related peptide receptor antagonist indicated for the acute treatment of migraine with or without aura in adults [citation], used as a nasal spray for patients [citation], and approved by the FDA in February 2020 [citation].
Figure 1: Chemical structure depiction of Zavegepant, Source
For What Is Used Zavzpret (Zavegepant)?
In the last few years, enormous efforts have been made to study the pathophysiology and description of the process to understand acute migraines, followed by uncomfortable symptoms, and create the best treatment possible. One of the new and promising solutions in migraine treatment is Zavzpret [citation].
Zavzpret belongs to the third generation of the calcitonin gene-related peptide receptor (CGRP) antagonist, with high-affinity, selective, and structurally unique features [citation]. CGRP is significantly associated with migraine pathophysiology, and for scientists, it has been an interesting "point" for research since the 1980s [citation].
Migraine comprises complex neurobiological features and processes, often described as a chronic illness or disability and neurological disorder [citation; citation; citation]. However, environmental and genetic factors are only some of the influences on the development of migraine; affecting the central nervous system (CNS), which has also been described in young adults, representing a severe condition accompanied by the following stages:
Collective studies have identified specific triggers of acute migraine, which include the following:
Stress
Noise
Hormonal changes in females (experienced during menstruation or exogenous hormone usage)
Changes in the duration of sleep,
Hunger,
Changes in the weather,
Bright light,
Dehydration,
Dietary factors,
Odors, and alcohol [citation].
Problems arise due to symptoms that appear in the form of irritability, lack of concentration, yawning, problems sleeping or speaking (participating in basic daily activities), depression, nausea, fatigue, frequent urination, or problems with muscle stiffness [citation].
Who Developed Zavzpret (Zavegepant)?
Zavzpret (Zavegepant; BHV-3500) also known as Vazegepant, was developed by Pfizer Inc and produced by Biohaven [citation; citation]. Pfizer is a multinational pharmaceutical company headquartered in New York in the United States of America, founded way back in 1849 by German scientists. They are mainly known as leaders in drug research and for producing penicillin, then drugs for cancer, endocrinology, cardiology, neurology, and immunology. It is essential to mention their importance in developing vaccines, emphasizing the Pfizer-BioNTech COVID-19 vaccine during the last pandemic.
What Is the Mechanism of Action?
Migraine is associated with the simulation of the trigeminovascular system, where CGRP is released. This phase detects it at high levels in the Trigeminovascular system and cerebrovascular circulation [citation].
Zavegepant is a CGRP receptor antagonist. In addition to this substance, neurokinin A, nitric oxide, and substance P are also considered participants in the neurovascular expansion mechanism of depression and are described as vasoactive substances. The CGRP increases and modulates processes of acute migraine: neural excitability and vasodilation. In this way, the pain characteristic of migraines is transmitted through the mentioned processes. So, Zavegepant is designed to prevent vasodilation and thus successfully reduce pain and migraine [citation; citation; citation; citation].
What Are the Key Advantages of Zavzpret (zavegepant)?
The following characteristics characterize the critical advantages of Zavegepant:
The first CGRP receptor antagonist for intranasal administration in the late-stage development of migraine,
Low potential for drug-drug interactions (confirmed by in vitro studies)
Favorable Tmax property and rapid absorption (The time when the drug is in the highest concentration, absorbed and eliminated in the body) [citation; citation],
The confirmed safety profile of the drug: No hepatotoxicity [citation].
What Are the Key Warnings and Precautions?
Warnings refer to the following:
Hypersensitivity reaction (facial swelling or urticaria),
Hypersensitivity reaction to other components of the drug [citation].
Additionally, Zavzpret is not intended for preventive use for migraines [citation].
What Are the Key Adverse Reactions?
The most common adverse drug reactions include:
Most key ADRs related to Zavzpret usually pass painlessly and without intervention [citation].