Aquipta side effects and hair loss are among the most searched concerns for patients starting this preventive migraine treatment in the UK. Aquipta (atogepant) is an oral CGRP receptor antagonist licensed by the MHRA for adults experiencing four or more migraine days per month. Whilst nausea and constipation are its most commonly reported side effects, many patients wonder whether hair thinning or shedding is linked to the medicine. This article explains what the clinical evidence and UK product information say about Aquipta's side effect profile, when to seek medical advice, and what treatment alternatives are available on the NHS.

What Is Aquipta and How Is It Used in the UK?

Aquipta (atogepant) is an MHRA-licensed oral CGRP receptor antagonist taken at 60 mg once daily to prevent migraine in adults with at least four migraine days per month, typically prescribed by neurologists or specialist headache clinics.

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Aquipta (atogepant) is an oral calcitonin gene-related peptide (CGRP) receptor antagonist licensed in the UK for the preventive treatment of migraine in adults who have at least four migraine days per month. In the United States, the same medicine is marketed under the brand name Qulipta; however, the UK-authorised brand is Aquipta. The medicine is authorised by the Medicines and Healthcare products Regulatory Agency (MHRA) for use in Great Britain; the European Medicines Agency (EMA) authorisation is relevant to Northern Ireland under the Windsor Framework.

Atogepant works by blocking the CGRP receptor, thereby interrupting the neurogenic inflammatory pathway believed to play a central role in migraine pathophysiology. CGRP is a neuropeptide released during migraine attacks that causes vasodilation and sensitisation of pain pathways; by blocking its receptor, atogepant helps reduce both the frequency and severity of migraines over time. Unlike acute migraine treatments, Aquipta is taken daily to reduce the frequency of migraine episodes rather than to treat an attack once it has started.

In the UK, Aquipta is typically considered for patients who have not responded adequately to, or cannot tolerate, established preventive therapies such as beta-blockers, topiramate, or amitriptyline, in line with NICE guideline NG150 (Headaches in over 12s: diagnosis and management). Prescribing decisions are generally made by neurologists or specialist headache clinics.

The standard licensed dose is 60 mg once daily, taken orally with or without food. However, the UK Summary of Product Characteristics (SmPC) also provides for lower doses of 10 mg or 30 mg once daily in certain circumstances — for example, when Aquipta is used alongside strong CYP3A4 inhibitors (such as clarithromycin or itraconazole), or in patients with significant hepatic or renal impairment. Aquipta is contraindicated in severe hepatic impairment. Patients and prescribers should consult the full MHRA/EMC SmPC for complete dosing and contraindication guidance.

As with all preventive treatments, an initial trial period of at least 12 weeks is recommended before assessing effectiveness. Continuation of treatment is generally supported where a patient achieves a ≥50% reduction in monthly migraine days (episodic migraine) or a ≥30% reduction (chronic migraine), consistent with NICE technology appraisal criteria for CGRP-targeting therapies. Thereafter, regular review every three to six months is advised.

Common and Reported Side Effects of Aquipta

The very common side effects of Aquipta are nausea and constipation; hair loss is not a recognised side effect in the UK SmPC, and anecdotal reports of alopecia are unconfirmed in clinical studies.

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Like all medicines, Aquipta can cause side effects, although not everyone will experience them. The adverse reactions listed below are based on the UK SmPC and clinical trial data; frequency categories follow standard EU/MHRA conventions.

Very common (affecting more than 1 in 10 people):

• Nausea — typically mild to moderate in severity

• Constipation

Common (affecting up to 1 in 10 people):

• Fatigue and somnolence — some patients report feeling unusually tired, particularly in the early weeks of treatment

• Decreased appetite — weight loss has been observed in some individuals taking atogepant

• Elevated liver enzymes (ALT/AST increases) — transaminase elevations have been reported; these are generally asymptomatic but are monitored in clinical practice

Regarding hair loss (alopecia), it is important to note that this is not listed as a recognised side effect of Aquipta in the current MHRA-approved SmPC or EMA product information. There is no established pharmacological link between atogepant and hair loss. Some patients taking various CGRP-targeting therapies have anecdotally reported changes in hair texture or shedding, but these reports are not confirmed in clinical literature and should be regarded as anecdotal only.

It is also worth considering that migraine itself, as well as the stress associated with chronic pain conditions, can contribute to a type of hair shedding known as telogen effluvium. Nutritional changes linked to decreased appetite — a known side effect of Aquipta — could theoretically affect hair health over time, though this remains speculative and is not confirmed in clinical studies. Any new or unexplained hair loss whilst taking Aquipta should be discussed with a healthcare professional to rule out other underlying causes.

If you think you are experiencing a side effect from Aquipta, you can report it directly to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk or through the Yellow Card app. Reporting suspected adverse reactions helps the MHRA monitor the ongoing safety of medicines.

When to Speak to Your GP or Specialist

Seek prompt medical advice if you experience persistent nausea, significant unintentional weight loss, noticeable hair thinning, severe fatigue, or any liver-related symptoms such as jaundice whilst taking Aquipta.

Whilst many side effects of Aquipta are mild and tend to improve as the body adjusts to the medication, there are certain situations where it is important to seek prompt medical advice. You should contact your GP or prescribing specialist if you experience:

• Persistent or worsening nausea that is affecting your ability to eat or drink

• Significant unintentional weight loss over a short period

• Noticeable hair thinning or shedding that is new, progressive, or causing distress — even though hair loss is not a confirmed side effect of Aquipta, it warrants investigation to exclude other causes

• Severe fatigue or somnolence that is disproportionate or interfering with daily activities — avoid driving or operating machinery until you know how Aquipta affects you

• Liver-related symptoms, including jaundice (yellowing of the skin or eyes), dark urine, or persistent upper abdominal pain; Aquipta has been associated with liver enzyme elevations and is contraindicated in severe hepatic impairment

If you develop signs of a severe allergic reaction — such as swelling of the face, lips, tongue, or throat, difficulty breathing, or a widespread rash — call 999 or go to your nearest A&E immediately. For urgent medical advice that is not an emergency, contact NHS 111 (online at 111.nhs.uk or by telephone).

If you are concerned about hair loss specifically, your GP may wish to check for other common causes such as thyroid dysfunction, iron deficiency anaemia, or hormonal changes — all of which are unrelated to Aquipta but are important to exclude.

Pregnancy and breastfeeding: Aquipta is not recommended during pregnancy. Women of childbearing potential should use effective contraception during treatment and discuss this with their prescriber before starting. Aquipta is also not recommended during breastfeeding; the risks and benefits should be discussed with a healthcare professional, as advised in the SmPC.

Drug interactions: Atogepant is metabolised via CYP3A4 and is also a substrate of drug transporters. Strong CYP3A4 inhibitors (e.g., clarithromycin, itraconazole, ketoconazole) can significantly increase atogepant exposure and require a dose reduction to 10 mg once daily. Strong CYP3A4 inducers (e.g., rifampicin, carbamazepine, St John's Wort) may reduce efficacy and should generally be avoided. Always inform your pharmacist or doctor of all other medicines, supplements, and herbal remedies you are taking.

Managing Side Effects and Treatment Alternatives

Most Aquipta side effects are manageable with practical measures; NHS alternatives include topiramate, propranolol, rimegepant (Vydura), and injectable anti-CGRP monoclonal antibodies such as erenumab, fremanezumab, and galcanezumab.

For most patients, the side effects of Aquipta are manageable and do not require stopping treatment. Practical strategies to help minimise common adverse effects include:

• For nausea: taking the tablet with a small amount of food, staying well hydrated, and avoiding large meals immediately after dosing

• For constipation: increasing dietary fibre and fluid intake; a short-term osmotic laxative may be appropriate if symptoms persist — discuss this with your pharmacist

• For fatigue or somnolence: taking the dose at a consistent time each day, ideally in the evening if daytime drowsiness is problematic, and ensuring good sleep hygiene; do not drive or operate machinery if affected

• For decreased appetite: monitoring weight regularly and ensuring nutritional intake remains adequate; if weight loss is significant, inform your GP

If hair loss is a concern and investigations confirm it is related to nutritional deficiency secondary to reduced appetite, addressing dietary intake or considering supplementation (under medical guidance) may be beneficial. If hair loss persists without a clear alternative explanation, your prescriber may consider whether an alternative preventive migraine therapy is more appropriate for you.

Alternative preventive treatments for migraine available in the UK include:

• Topiramate, propranolol, and amitriptyline — established oral options recommended in NICE guideline NG150

• Rimegepant (Vydura) — an oral CGRP receptor antagonist approved by NICE (TA906) for the prevention of episodic migraine in adults, taken every other day; this is another oral option for patients who cannot tolerate or have not responded to conventional preventives

• Erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality) — injectable anti-CGRP monoclonal antibodies, each with NICE technology appraisals (TA682, TA764, and TA659 respectively) defining eligibility and NHS funding criteria

For CGRP-targeting therapies, NICE technology appraisals generally require a ≥50% reduction in monthly migraine days (episodic migraine) or ≥30% reduction (chronic migraine) after an initial 12-week treatment period to support continuation of therapy.

Ultimately, the decision to continue, adjust, or switch treatment should be made collaboratively between the patient and their healthcare team, weighing the benefits of migraine prevention against any troublesome side effects. An initial efficacy review at approximately 12 weeks is recommended, followed by regular review appointments every three to six months to assess both efficacy and tolerability.

For further information, visit the NHS migraine pages at nhs.uk, or speak to your GP, pharmacist, or specialist headache team. Suspected side effects can be reported to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk.

Frequently Asked Questions