Fremanezumab
CGRP antagonists (gepants and anti-CGRP antibodies)
CGRP antagonists (gepants and anti-CGRP antibodies)
A monoclonal antibody that traps the CGRP peptide. Injected under the skin monthly or every three months to prevent migraine.
Also called: Fremanezumab-vfrm
Quick facts
- Group
- CGRP antagonists (gepants and anti-CGRP antibodies)
- Target
- CGRP peptide (the ligand, not the receptor)
- Used for
- Prevention of migraine in adults
- Key effects
- Pain
- Monitor
- Headache diary to judge the benefit · Blood pressure
- ATC
- N02CD03
No doses: the clinician sets them by the current guideline.
Mechanism of action
Fremanezumab is a monoclonal antibody that binds the CGRP peptide itself and stops it from reaching and activating its receptor. Less CGRP signalling from the trigeminal system means less vasodilation and neurogenic inflammation, and fewer migraine days over the following months.
- Fremanezumab binds circulating CGRP
- CGRP cannot reach its receptor
- Less trigeminovascular inflammation
- Fewer migraine days
Indications
- Prevention of migraine in adults Migraine →
Adverse effects
Common
- Pain, swelling or redness at the injection site
Contraindications
- Hypersensitivity to fremanezumab or any component of the product
Key interactions
- Acute migraine medicines
- Still needed for attacks: fremanezumab prevents migraine but does not stop an attack
What is monitored
- Headache diary to judge the benefit
- Blood pressure
- Fingers and toes for Raynaud symptoms
Administration and safety
- Taken out of the refrigerator and left about 30 minutes to reach room temperature, never warmed
- Injected under the skin of the thigh, upper arm or abdomen, avoiding tender, bruised, red or scarred skin
- The three-monthly regimen is three injections one after another
- Each syringe or device is used once and discarded in a sharps container
Pregnancy and breastfeeding
There is little information in pregnancy; it is a decision for the treating team.
Nursing care
- Teach injection technique and safe sharps disposal
- Ask about high blood pressure and Raynaud phenomenon
- Explain that allergic reactions can be delayed by days to weeks
- Remind that attack medicines are still needed
Pharmacokinetics
- Absorption
- Subcutaneous injection
- Elimination
- Long-acting antibody: given monthly or every three months
Test yourself
Think of the answer, then tap the question to see it.
What does fremanezumab bind?
The CGRP peptide (the ligand), not its receptor.
How often is fremanezumab given?
Once a month or once every three months, under the skin.
Which anti-CGRP antibody binds the receptor instead of the peptide?
Erenumab.
Connections
← Back to the class: CGRP antagonists (gepants and anti-CGRP antibodies)
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Fremanezumab-vfrm Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.