Is it safe to use monthly injectable CGRP antagonists with oral gepants in the same patient?

Yes. To my knowledge, there is no data to suggest that it is not. I have routinely used oral gepants as abortive treatment in patients who are on a CGRP monoclonal antibody for prevention.

There have been at least 2 retrospective studies looking at the safety and tolerability of using oral gepants in patients on CGRP Mabs.

In a study by Alsaadi et al., PMID 38361080, 234 patients were treated with rimegepant or ubrogepant in addition to CGRP Mab, and there were no serious adverse events. There wer...

In a patient on a CGRP antibody for migraine prevention, I prefer to use a triptan abortively but would have no hesitation in using a gepant. So far, I have not seen any negative consequences of combining a CGRP antibody preventively with a gepant abortively.