Fremanezumab is administered as a subcutaneous injection. It is available in pre-filled syringes or autoinjectors, which can be administered by a healthcare professional, or by the patient or a caregiver at home after proper training.

• Preparation: Before injection, remove the pre-filled syringe or autoinjector from the refrigerator and allow it to sit at room temperature for at least 30 minutes. Do not warm it using a heat source (e.g., hot water, microwave). Do not shake the syringe/autoinjector.
• Injection Site: Inject into areas of the abdomen, thigh, or upper arm that are not tender, bruised, red, or indurated. For multiple injections (when administering the quarterly dose), you may use the same body site but not the exact same location of the previous injection.
• Technique (Autoinjector): Place the autoinjector at a 90-degree angle against the cleaned skin. Press down firmly; you will hear a “CLICK” indicating the injection has started. Continue to hold down firmly for about 30 seconds until a second click is heard.
• Disposal: Dispose of the used syringe or autoinjector immediately in an FDA-cleared sharps disposal container.
• Missed Dose: If a dose is missed, administer it as soon as possible. Subsequent doses can then be scheduled monthly or every 3 months from the date of the last administered dose.

Fremanezumab works by targeting a specific substance in the body that plays a key role in causing migraine headaches.

• Calcitonin Gene-Related Peptide (CGRP) Inhibition: Fremanezumab is a fully humanized monoclonal antibody that selectively binds to calcitonin gene-related peptide (CGRP). CGRP is a naturally occurring protein that is released during a migraine attack and is involved in transmitting pain signals. By binding to CGRP, Fremanezumab prevents CGRP from attaching to its receptors, thereby blocking its activity. This action helps to reduce the frequency, duration, and severity of migraine attacks.

Unlike many older migraine preventive medications that were not specifically developed for migraine pathophysiology, Fremanezumab directly targets a key pathway involved in migraine generation.

Like all medications, Fremanezumab can cause side effects. The most common side effects are generally mild and localized.

• Common Side Effects (at the injection site):
  • Pain
  • Redness (erythema)
  • Itching (pruritus)
  • Swelling (induration)
  • Bruising
• Less Common / Serious Side Effects (Seek medical attention if these occur):
  • Hypersensitivity Reactions: Allergic reactions, including rash, hives, pruritus, and rarely more severe reactions like anaphylaxis (severe allergic reaction with symptoms such as difficulty breathing, swelling of the face/lips/tongue/throat, racing heart, dizziness) or angioedema. These can occur at any time during treatment, up to one month after an injection.
  • Hypertension (High Blood Pressure): New-onset or worsening of pre-existing hypertension has been reported in the postmarketing setting.
  • Raynaud’s Phenomenon: New-onset or worsening of pre-existing Raynaud’s phenomenon (reduced blood flow to fingers/toes causing numbness or coldness) has been reported.

Report any new or worsening symptoms to your healthcare provider immediately.

Before starting Fremanezumab, your doctor will assess your medical history carefully.

• Hypersensitivity Reactions: Fremanezumab is contraindicated in patients with a history of serious hypersensitivity to fremanezumab-vfrm or any of its components. If a serious allergic reaction occurs, Fremanezumab should be discontinued, and appropriate therapy instituted.
• Hypertension: Patients should be monitored for new-onset or worsening of pre-existing hypertension.
• Raynaud’s Phenomenon: Patients with a history of Raynaud’s phenomenon should be monitored for worsening or recurrence of symptoms. If new symptoms develop, consider discontinuing Fremanezumab.
• Children: The safety and efficacy of Fremanezumab in children and adolescents under 18 years of age have not been established.
• Pregnancy and Breastfeeding: It is not known whether Fremanezumab is safe to inject during pregnancy or whether it passes into breast milk. If you are pregnant, planning a pregnancy, or breastfeeding, discuss the risks and benefits with your doctor.
• Storage and Handling: Do not freeze or shake Fremanezumab. Allow it to reach room temperature for 30 minutes before injection; do not warm it with heat.

Always follow your doctor’s instructions and the product’s prescribing information.

In clinical trials, it has not shown interactions with commonly used acute migraine medications or other preventive treatments. However, it is always important to inform your doctor or pharmacist about all prescription, over-the-counter, herbal, and vitamin supplements you are taking.

While specific interactions are rare, some general considerations apply:

• Other CGRP Pathway Inhibitors: Combining Fremanezumab with other medications that target the CGRP pathway (e.g., other CGRP monoclonal antibodies or gepants) is generally not recommended or has not been fully studied.
• Alcohol: While Fremanezumab does not directly interact with alcohol, alcohol can be a migraine trigger for some individuals. It’s advisable to limit or avoid alcohol if it triggers your migraines.
• Vaccines and Lab Tests: There are currently no reported interactions with vaccines or common lab tests.

Your healthcare provider will assess your complete medication list to ensure Fremanezumab is a safe and appropriate option for you.

Fremanezumab offers flexible dosing options for the preventive treatment of migraine in adults.

• Monthly Dosing: The recommended dosage is 225 mg subcutaneously once a month.
• Quarterly Dosing: Alternatively, 675 mg subcutaneously once every 3 months. The 675 mg dose is administered as three consecutive subcutaneous injections of 225 mg each, given at different injection sites during the same visit.
• No Loading Dose: A loading dose is generally not required or recommended when initiating treatment.
• Switching Regimens: If switching between monthly and quarterly dosing, the first dose of the new regimen should be administered on the next scheduled date of administration.
• Missed Dose: If a dose is missed, it should be administered as soon as possible. Subsequent doses should then be scheduled monthly (225 mg doses) or every 3 months (675 mg doses) from the date of the last administered dose.

Your doctor will determine the most appropriate dosing schedule based on your individual needs and medical condition.

Fremanezumab (Ajovy) is a prescription-only medication. You cannot obtain it without a valid prescription from a licensed healthcare professional.

• Specialist Initiation: Treatment with Fremanezumab is typically initiated by a physician experienced in the diagnosis and treatment of migraine.
• Diagnosis Confirmation: It is prescribed for adults who have frequent migraine days (e.g., at least 4 migraine days per month).
• Medical Oversight: Due to its nature as a monoclonal antibody and its use in a chronic condition, ongoing medical supervision is required to assess treatment benefit and manage any potential side effects.
• Patient Training: If you will be self-injecting, your healthcare provider will provide thorough training on the proper subcutaneous injection technique.

Therefore, Fremanezumab is prescribed and managed under the strict supervision of a qualified healthcare professional who will assess its appropriateness for your condition and monitor your progress.

What is Fremanezumab used for? Prevention of episodic and chronic migraine in adults

2. What is the active ingredient? Fremanezumab-vfrm

3. What drug class does it belong to? Monoclonal antibody (CGRP antagonist)

4. Is it a controlled substance? No

5. Is it available in generic form? No

6. How is Fremanezumab administered? Subcutaneous injection

7. What strengths are available? 225 mg/1.5 mL prefilled syringe or autoinjector

8. What is the usual adult dosage? 225 mg monthly OR 675 mg every 3 months

9. Can it be used in children? Not approved for pediatric use

10. What are common side effects? Injection site pain, redness, itching

11. Can it cause serious reactions? Rare—hypersensitivity reactions (rash, swelling, difficulty breathing)

12. Is it safe during pregnancy? Limited data; use only if benefits outweigh risks

13. Is a prescription required? Yes

14. Is Fremanezumab available in Pakistan? Not widely; may be accessed via import programs

15. How should it be stored? Refrigerated at 2–8°C; protect from light; do not freeze

16. What precautions should be taken during use? Monitor for allergic reactions; rotate injection sites

17. What are contraindications? Hypersensitivity to fremanezumab or excipients

18. What monitoring is needed during use? No routine labs; monitor clinical response and adverse effects

19. Can it be combined with other migraine medications? Yes—can be used with triptans, NSAIDs, or preventive agents

20. What are similar drugs? Erenumab (Aimovig), galcanezumab (Emgality), eptinezumab (Vyepti)