In September 2022, the second calcitonin gene-related monoclonal (CGRP) monoclonal antibody medication called Emgality (galcanezumab) was launched in New Zealand.
Since the launch, we’ve received many questions about who can prescribe Emgality, which pharmacists stock it and how it’s given.
We’ve put together these Frequently Asked Questions to help. If there’s a question that’s not answered here, feel free to email us at info@migrainefoundation.org.nz and we’ll add it to the list.
Who can prescribe Emgality?
Emgality can be prescribed by your GP and doesn’t require a prescription from a neurologist. Because Emgality is new to New Zealand, many GPs won’t be familiar with prescribing Emgality so may want to research it before prescribing.
What pharmacy can I get Emgality from?
Emgality should be available through any pharmacy in New Zealand. The wholesaler is CDC Pharmaceuticals, but even pharmacies that don’t usually purchase medications from CDC can still purchase Emgality through them.
CDC Pharmaceuticals is keeping a close eye on the stock. It should be available from all of their warehouses and, once ordered, arrive at the pharmacy overnight or within a day or two. CDC Pharmaceuticals is happy to be contacted with any questions or issues (email Murray Campbell, General Manager – Hospital, CDC Pharmaceuticals Ltd, at murray@cdc.co.nz).
What is the dosage?
Emgality is available as a 120mg dose, administered by a self-injection pen. Two injections (240mg) are given initially, then one (120mg) every 4 weeks.
How much does Emgality cost?
Emgality is not funded by Pharmac, so you have to pay for it privately.
The price is around $325 per 120mg injection but will vary between pharmacies depending on their dispensing fee. Grafton Pharmacy in Auckland is offering it at $325 per dose, plus a courier fee of around $50 if you can’t pick it up. To find the best price in your area, it may be worth phoning around various pharmacies and mentioning the Grafton Pharmacy price.
Many people are sharing which pharmacies they’ve got Emgality through on our private Facebook support group. If you’re on Facebook, please join the Migraine Foundation Aotearoa Support group to keep up on Emgality and other migraine news and sharing.
How is Emgality administered?
Emgality is administered by a self-injection pen. It’s a subcutaneous injection (given just under the skin), that you can do at home by yourself. Your GP or nurse may be able to help you administer your first injection. You can inject Emgality into your abdomen or outer thigh.
Emgality needs to be kept refrigerated. Take the pen out of the fridge 30 minutes before you inject it, as it won’t sting as much at room temperature.
Instructions for administration are in the box and the Auto-injector factsheet is here
How often do I take Emgality?
Emgality is a 4-weekly injection. The first (loading) dose is 240mg (2 pens), then one pen (120mg) every 4 weeks.
What do I do with the injection pens after I’ve used them?
The injection pens have a retractable needle and shouldn’t be discarded in household rubbish. Most pharmacies can dispose of these safely and without charge – check with your local pharmacy.
Are there any side effects or contraindications?
Emgality is usually well tolerated, with fewer side effects than many other migraine preventive medications. The most common side effect is pain and redness at the injection site.
A contraindication is a reason not to take a particular medication. Currently, the only contraindication warning for Emgality is if you have an allergy to any of its ingredients. To ensure it’s safe for you, discuss it with your doctor before taking it.
For more information, see the Emgality Consumer Medication Information sheet from Medsafe
Is Emgality safe to take during pregnancy or breastfeeding?
The safety of Emgality in pregnancy is not yet known. It’s recommended to come off Emgality for five months before becoming pregnant because the risks are unknown. If you are pregnant or planning to become pregnant, discuss with your doctor before taking Emgality and see point 4.6 of the Emgality New Zealand Data Sheet
Will Emgality be funded by Pharmac?
We made a submission to Pharmac for funding of Emgality in November 2022 and in July 2024, Emgality was put on Pharmac’s Options for Investment list. This means Pharmac has assessed Emgality as a medication that should be funded but we don’t know how Emgality has been prioritised compared to the many other medications on this list. We now have to wait and see when it will be funded, which depends on how much money the Government allocates towards spending on medications.
What class of medication is Emgality?
Emgality is a calcitonin gene-related peptide (CGRP) monoclonal antibody medication. CGRP monoclonal antibodies are the first medications developed specifically to prevent migraine. They’ve been found to be safe and effective, with fewer side effects than many other preventive migraine medications.
The CGRP monoclonal antibodies block a small protein called CGRP that helps to transmit pain signals in the brain, ramp up inflammation and dilate blood vessels. The CGRP monoclonal antibodies bind to CGRP or to its receptor sites found in some parts of the nervous system, effectively turning off its ability to stimulate the cascade of events that lead to a migraine attack.
What other CGRP monoclonal antibody medications are available for migraine?
Since May 2018, the US Food and Drug Administration (FDA) has approved three injectable CGRP medications and one CGRP infusion:
- Aimovig (erenumab)
- Emgality (galcanezumab)
- Ajovy (fremanezumab)
- Vyepti (eptinezumab)
Aimovig, Emgality and Ajovy are given every 4 weeks by self-injection. Ajovy also has the option to be used quarterly, with three injections four times a year. Vyepti is a one-hour intravenous infusion every three months.
Aimovig is also available in New Zealand, but is also unfunded. It is available as a 70mg and 140mg dose. A 70mg injection costs $678 and 140mg costs $1,356.
Ajovy has been approved by Medsafe but is not available in New Zealand, and Vyepti is not approved by Medsafe. We are in contact with both pharmaceutical companies for Ajovy and Vyepti and will continue to encourage access in New Zealand.
Gepants are another type of anti-CGRP medication, available as an oral tablet or nasal spray. They were initially developed to acutely treat migraine when you have a migraine attack, although some can also be used as a preventive migraine medication.
Gepants can be a good option for people who cannot take or tolerate triptans or for whom triptans don’t work.
So far, four gepants have been developed. These are:
- Ubrogepant (Ubrelvy) for treatment of migraine attacks
- Rimegepant (Nurtec ODT) for both treatment of migraine attacks and migraine prevention
- Atogepant (Aquipta) for migraine prevention
- Zavegepant (Zavzpret) nasal spray for treatment of migraine attacks
Atogepant (Aquipta) has been approved by Medsafe and is also on Pharmac’s Options for Investment list. Atogepant is available through a special access programme at a cost of $352.80 for a month’s supply of 60mg tablets. This is currently only accessible through Airport Oaks Pharmacy but they will courier nationwide.
More gepants are also being developed.
References
Emgality (galcanezumab) Consumer Medicine Information, Medsafe
Galcanezumab New Zealand Data Sheet, Medsafe
Further reading
Emgality, Eli Lilly consumer information
