Emgality dosage, forms, and strengths

Emgality forms and strengths

Emgality is self-injected once per month using a prefilled syringe or injection pen. There is no oral dosage form. The active ingredient, galcanezumab, is like a small protein and would be destroyed by the digestive system.

• Single-dose prefilled syringe: 100 milligrams (mg) per milliliter (mL) solution, 120 mg/mL solution

• Single-dose prefilled pen: 120 mg per injection

Emgality dosage for adults

Emgality is FDA approved to reduce the incidence of migraine headaches and episodic cluster headaches during a cluster period. Emgality does not prevent all migraine or episodic cluster headaches nor is it used to treat an active migraine or cluster headache. People taking Emgality will still need to use acute migraine or cluster headache treatments such as triptans when a headache strikes.

Source: Epocrates

Emgality dosage for the preventive treatment of migraine headache

Emgality is FDA approved as a once-monthly injection to prevent migraine headaches. The basic mechanism of migraines is well understood and involves the activation of nerves in the head (cranial nerves), which then produce a small protein-like molecule called calcitonin gene-related peptide (CGRP). These peptides attach to receptors—a kind of molecular “switch”—on the smooth muscles of blood vessels in the head. When this happens, the cranial blood vessels rapidly widen, causing the pain and many symptoms of a migraine.

Galcanezumab, the active ingredient in Emgality, prevents CGRP from binding to the receptor, reducing the incidence of migraines each month. For most people, Emgality monthly doses will not completely eliminate migraine headaches, but instead, reduce the average number of migraine headache days per month. 

• Standard adult dosage for migraine headache prophylaxis: 120 mg subcutaneous injection once per month 

• Maximum adult dosage for migraine headache prophylaxis: 240 mg loading dose

Emgality dosage for the preventive treatment of episodic cluster headaches

Emgality is FDA approved as a once-monthly injection to reduce the incidence of episodic cluster headaches during a cluster episode. While healthcare professionals are uncertain about what causes episodic cluster headaches, there is evidence that, just like migraines, CGRP and blood vessel dilation in the head play a role in producing the pain and some other symptoms of cluster headaches. As with migraines, galcanezumab reduces the average number of weekly cluster headaches by preventing the widening of the head’s blood vessels. 

Emgality treatment will start at the beginning of a cluster headache episode. Monthly shots will continue until the end of the episode. As with migraines, Emgality is not intended to reduce the incidence of cluster headaches to zero. In placebo-controlled clinical trials, Emgality reduced the average number of weekly cluster headaches during the cluster period. 

• Standard adult dosage for the treatment of episodic cluster headaches: 300 mg subcutaneous injection once per month

• Maximum adult dosage for the treatment of episodic cluster headaches: 300 mg per month

Emgality dosage for children

Emgality is not used in children or adolescents. 

Emgality dosage restrictions

Emgality has no dosage restrictions. Like all prescription drugs, however, hypersensitivity to galcanezumab or any of its excipients (inactive ingredients) is a contraindication. Emgality treatment will stop if a person has a serious allergic reaction to the medicine.

How to take Emgality

Monthly doses are self-injected right beneath the skin using a single-dose prefilled syringe or the single-dose Emgality pen injector. A healthcare provider will demonstrate how to properly administer an injection. Each prescription will come with detailed instructions for use, so always go over these instructions carefully before administering an injection. For a video demonstration, Eli Lilly and Company, the manufacturer of Emgality, has provided video walkthroughs to help patients or caregivers administer injections.

• Take this medicine as directed by a healthcare provider.

• Each injection will require alcohol wipes, cotton balls or a piece of gauze, and a sharps disposal container.

• For most people, subcutaneous injections will be self-injected into the abdomen or front of the thigh or injected by a caregiver into the back of the upper arm or the buttocks. 

• Do not give injections into the same spot. The first dose of Emgality for migraines will involve two shots. Monthly doses of Emgality for treatment of episodic clusters will involve taking three shots at once. Always choose a different site for each injection. If you want to use the same area, for example, your abdomen, you can inject the second dose in another part of your abdomen. 

• People with vision or hearing problems should have their injections given by a caregiver.

• Do not inject the medicine into skin that is tender, bruised, red, or hard. 

• Wash your hands with soap and water before giving an injection.

• NEVER use a syringe or pen injector that looks damaged, has passed its expiration date, or has medicine that is frozen, looks cloudy, or has small particles floating in the solution. 

• NEVER shake the Emgality pen or prefilled syringe.

• Store the Emgality pen or prefilled syringe in the refrigerator (36°F to 46°F) in its original carton to protect the contents from light. Do not freeze.

• Emgality can be stored at room temperature (up to 86°F) for up to seven days. If it is not used before that time, safely dispose of the medicine. If Emgality is stored at room temperature, do not return it to the refrigerator.

• Keep this medicine out of the reach of children and pets.

Emgality Pen

• The Emgality pen is used only for people diagnosed with migraine headaches.

• Remove the Emgality pen from the medicine carton and, if there are more pens in the carton, return the carton to the refrigerator.

• Let the medicine stand at room temperature out of direct sunlight for 30 minutes. Do not run hot water on it or put it in the microwave to warm the medicine.

• Inspect the Emgality pen and the medicine. The instructions for use will tell you what to look for and when it’s not safe to use the pen injector.

• Clean the injection site with an alcohol wipe. Make sure the skin has dried before giving the injection.

• Pull the base cap off when ready to inject.

• Press the pen’s base firmly against the injection site and turn the lock ring to the unlock position.

• Press and hold the teal injection button. The pen will click.

• Hold the pen’s base firmly against the skin until the pen clicks a second time. This will take about 10 seconds.

• The injection is finished. Discard the Emgality pen in the sharps container.

• Inspect the injection site. If there’s blood, press a cotton ball or gauze strip to the site but do not rub the injection site.

Prefilled syringe

• The Emgality 100 mg single-dose prefilled syringe has a red plunger and is used only in people using Emgality for episodic cluster headaches. Three injections will be made once per month, starting at the beginning of the cluster period.

• The Emgality 120 mg single-dose prefilled syringe has a teal plunger and is used only in people using Emgality for migraine headaches. One injection will be administered once per month.

• Remove the medicine package from the refrigerator.

• Take out the number of syringes you will be using. If the carton contains other syringes, immediately return the carton to the refrigerator.

• Let the medicine stand at room temperature out of direct sunlight for 30 minutes. Do not heat it, microwave it, or run hot water over it to warm it up.

• Do not remove the needle cap until ready to inject.

• Inspect the syringe. The instructions will tell you what to look for and when it’s not safe to use.

• Clean the injection site with an alcohol wipe. Make sure the skin has dried before giving the injection.

• Pull the needle cap off when ready to inject.

• At the injection site, gently pinch the skin together. A healthcare provider will show you how to do this.

• Holding the barrel of the syringe, insert the syringe needle into the gathered skin at a 45-degree angle.

• With a thumb or finger, push the plunger rod slowly and with constant pressure all the way down until it stops.

• You will know the full injection has been made because the colored plunger rod will show through the entire syringe barrel when there’s no medicine left.

• Gently remove the needle. You can stop holding the skin with your other hand. 

• The injection is finished. Discard the syringe in the sharps container.

• Inspect the injection site. If there’s blood, apply gauze or a cotton ball. Do not rub the site.

Emgality dosage FAQs

How long does it take Emgality to work?

In pharmacokinetic studies, a single dose of Emgality reaches its peak effects in about five days. People taking Emgality for either migraine or cluster headache prophylaxis will see a reduction in migraine days or cluster headache attacks in the first month. Based on clinical studies, it may take up to five or six months of Emgality monthly doses for patients with chronic migraine or episodic migraines to hit their lowest average headache incidence.

What happens if I miss a dose of Emgality?

Take a missed dose as soon as it’s remembered. This will reset the monthly dosing schedule, so do not take the next scheduled dose until 30 days after the last dose.

How do I stop taking Emgality?

Emgality can be stopped at any time without problems. 

There are many reasons why people may wish to stop taking Emgality. It may not work for some people. Side effects such as hives, rash, and trouble breathing may signal a possible allergic reaction. Serious hypersensitivity reactions will require emergency medical attention and discontinuation of the medication. Finally, some people just get tired of giving themselves injections or dealing with injection site reactions.

There are other alternatives to prevent migraines and cluster headaches. If someone cannot use Emgality, there are other effective treatments for migraine prevention including topiramate, nortriptyline, and botulinum toxin, as well as other monoclonal antibodies such as Aimovig (erenumab), Vyepti (eptinezumab), and Ajovy (fremanezumab). The standard preventive treatments of cluster headaches are steroid injections, verapamil, and, less commonly, lithium, oral steroids, melatonin supplements, intranasal capsaicin, or valproic acid.

What is the maximum dosage for Emgality?

For treatment of migraine headaches, the maximum Emgality dosage is a 240 mg first dose. For the treatment of cluster headaches, the 300 mg monthly dose is also the maximum dose. 

What interacts with Emgality?

Emgality has no known drug interactions.

What happens when you mix Emgality and alcohol?

Emgality is taken monthly to prevent migraine or cluster headaches. Alcohol consumption is not prohibited or discouraged in people taking Emgality. However, alcohol is a well-known trigger for migraine headaches and a main trigger for cluster headaches. For this reason, healthcare providers will ask people diagnosed with migraines or cluster headaches to stop drinking alcohol.

Is it safe to take Emgality during pregnancy?

Emgality has not been studied in pregnant women, so it has not been determined as safe. There are also no studies on whether galcanezumab is present in breast milk or if it affects lactation or a nursing infant. Women who are pregnant, planning to become pregnant, or breastfeeding should get medical advice from a healthcare provider about the risks and benefits of Emgality use.

Related resources for Emgality dosages:

• Alcohol and migraine, American Migraine Foundation

• Calcitonin gene-related peptide receptors, StatPearls

• Cluster headache, StatPearls

• Differences in clinical features of cluster headache between drinkers and nondrinkers in Japan, PLOS ONE

• Emgality, Epocrates

• Emgality prescribing information, U.S. National Library of Medicine

• Emgality, Eli Lilly and Company

• Galcanezumab-gnlm drug summary, Prescriber’s Digital Reference

• Reducing episodic cluster headaches: Focus on galcanezumab, Journal of Pain Research