Symbravo (Meloxicam and Rizatriptan) for Migraine

Symbravo (meloxicam and rizatriptan) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to treat migraine attacks, with or without aura, in adults.

How Symbravo Works and How It’s Taken

Symbravo is a combination medicine that contains meloxicam and rizatriptan. Meloxicam blocks COX enzymes and lowers substances called prostaglandins that help cause pain and inflammation. Rizatriptan is a triptan that works on serotonin receptors linked to migraine and affects blood vessels and nerves involved in migraine pain.

Part of how Symbravo works is not fully understood. Doctors prescribe Symbravo when adults have migraine attacks, with or without aura, after migraine has been clearly diagnosed.

Symbravo is given as a tablet by mouth when needed for the acute treatment of a migraine attack. Do not crush, divide, or chew Symbravo tablets. It can be taken with or without food.

Typical Dosing for Migraine

The recommended dose of Symbravo for migraine is one tablet containing 20 milligrams of meloxicam and 10 milligrams of rizatriptan, taken by mouth as needed for migraine.

Do not take more than one tablet in one day. The safety and effectiveness of a second dose for the same migraine attack have not been established. The safety of treating, on average, more than seven headaches in a 30-day period has not been established.

This information is based on the prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Symbravo Side Effects

In clinical studies of Symbravo for the acute treatment of migraine with or without aura in adults, the most common side effects occurred in about 2 percent of people. These include:

Somnolence (sleepiness)
Dizziness

Serious Side Effects and Warnings

Symbravo can cause serious side effects that may require immediate medical attention. These include:

Cardiovascular thrombotic events and myocardial infarction — Serious heart and blood vessel events, including heart attack and stroke, can be fatal.
Gastrointestinal bleeding, ulceration, and perforation — Serious stomach or intestinal problems, such as bleeding, ulcers, or a tear called a perforation, can be fatal.
Arrhythmias — Dangerous heart rhythm problems can be life-threatening.
Cerebrovascular events — Bleeding in the brain or stroke can occur and may be life-threatening.
Anaphylactic reactions — Severe allergic reactions can cause trouble breathing, swelling, or shock.
Chest, throat, neck, or jaw tightness, pain, pressure, or heaviness — These sensations can happen after a dose and may need urgent evaluation if they are heart-related.
Vasospasm reactions — Blood vessel spasms in other parts of the body can reduce blood flow and affect the arms, legs, gut, or other organs, and can include Raynaud’s syndrome.
Hepatotoxicity — Liver injury can lead to liver failure.
Hypertension — Increased blood pressure may occur during treatment.
Heart failure and edema — Fluid retention can cause swelling and shortness of breath.
Renal toxicity and hyperkalemia — Kidney injury, including acute kidney failure and high potassium levels, can occur.
Serious skin reactions — These can include Stevens-Johnson syndrome, toxic epidermal necrolysis, and fixed drug eruption.
Drug reaction with eosinophilia and systemic symptoms (DRESS) — This severe drug reaction can include rash, fever, and organ problems.
Fetal toxicity during pregnancy — Problems can include fetal kidney function problems and low amniotic fluid.
Hematologic toxicity — Anemia and other bleeding problems can include low red blood cells or an increased bleeding risk.
Exacerbation of asthma related to aspirin sensitivity — Worsening asthma can occur in people sensitive to aspirin, which may cause serious breathing problems.
Medication overuse headache — More frequent or worse headaches can occur from using acute migraine medicines too often.
Serotonin syndrome — This potentially life-threatening reaction can cause agitation, confusion, sweating, tachycardia (fast heartbeat), muscle stiffness, or fever.
Seizure — A sudden change in brain activity can cause shaking or loss of awareness.

Get medical help right away if you think you are having a serious reaction.

How To Save on Symbravo

Axsome Therapeutics, the manufacturer of Symbravo, offers the Symbravo OnMySide Savings Program. Eligible people with commercial insurance may pay as little as $0 a month for their prescription.

The Symbravo OnMySide Savings Program also offers a Symbravo Savings Card, including activation and help verifying coverage, as well as prescription fulfillment coordination. The offer is not available to people with Medicare, Medicaid, or other government-funded insurance.

To learn more, visit the Symbravo copay page.

What To Know Before Taking Symbravo

Before prescribing Symbravo, your doctor may check your heart health, especially if you have risk factors for heart disease. These risk factors include high blood pressure, diabetes, smoking, obesity, high cholesterol, or a family history of heart disease.

Tell your doctor if you are allergic to meloxicam, rizatriptan, aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), or any ingredients in Symbravo.

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

Propranolol-containing medicines, such as Inderal, Inderal LA, or Innopran XL
Medicines used to help your mood, including selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs)
Aspirin
Anticoagulant medicines

Do not take Symbravo if you:

Have ischemic coronary artery disease or other significant heart or blood vessel disease
Have coronary artery vasospasm, including Prinzmetal’s angina
Are having or recently had coronary artery bypass graft (CABG) surgery
Have had a stroke or transient ischemic attack (TIA)
Have hemiplegic migraine or basilar migraine
Have peripheral vascular disease or ischemic bowel disease
Have uncontrolled high blood pressure
Take propranolol-containing medicines
Have taken another triptan or an ergot-containing medicine within the last 24 hours
Take a monoamine oxidase-A (MAO-A) inhibitor or stopped taking one within the last two weeks
Are allergic to meloxicam, rizatriptan, NSAIDs, or any ingredient in Symbravo
Have had asthma, hives, or another allergic reaction after taking aspirin or another NSAID
Have moderate to severe kidney problems and are at risk for kidney failure due to low body fluid levels or are on dialysis

Do not take Symbravo right before or after a heart surgery called coronary artery bypass graft. Avoid taking Symbravo after a recent heart attack unless your doctor tells you to.

If you are pregnant, planning to become pregnant, or breastfeeding while taking Symbravo, talk with your doctor about the risks and benefits. Avoid using Symbravo at about 30 weeks of pregnancy and later. Between about 20 and 30 weeks of pregnancy, use the lowest effective dose for the shortest time possible.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Symbravo?

In studies of adults treating a migraine attack, 19.9 percent of people taking Symbravo were pain free two hours after taking the medicine, compared with 6.7 percent of people taking placebo (an inactive treatment).

In another study where people treated migraine when the pain was still mild, 32.6 percent of people taking Symbravo were pain free at two hours, compared with 16.3 percent taking placebo. Symbravo also helped more people become free from their most bothersome migraine symptoms, such as nausea, sensitivity to light, or sensitivity to sound, at two hours after treatment.

Some people also stayed pain free from two to 24 hours after taking Symbravo.

How long does Symbravo take to work for migraine?

The main clinical studies measured how well Symbravo worked two hours after people took it. At that time, more people taking Symbravo were free from migraine pain or had relief from their most bothersome symptoms compared with people taking placebo.

Under fasting conditions, Symbravo reached its median peak blood levels in less than one hour. However, the clinical studies measured effectiveness at two hours after dosing.

What tests or monitoring are needed with Symbravo for migraine?

Blood pressure should be checked when Symbravo is started and during treatment. In people taking long-term NSAID treatment, doctors may check a complete blood count (CBC) and chemistry profile from time to time because serious bleeding, liver problems, and kidney injury can happen without warning symptoms.

People with kidney or liver problems, heart failure, dehydration, or low blood volume may also need kidney function monitoring.