Nurtec for Dry Eye Disease, Corneal Neuropathy and Neurotrophic Keratitis - Toyos Protocol

Nurtec for Dry Eye Disease, Corneal Neuropathy and Neurotrophic Keratitis
Dry eye Disease DED is a multifactorial disease that can cause excruciating pain. Even though Jennifer Anniston and Jennie Garth have brought celebrity status to this disease, there are still precious few FDA approved medications and treatments for DED. In the last couple of years more research has been devoted to the treatment of DED. We are finding that some common medications and treatments for other diseases may have use in Eye Care. Think Intense Pulse Light for DED. We now have a migraine medicine that may help one of the toughest problems in DED - corneal neuropathy. Our clinic has been at the forefront of DED treatment research and we believe Nurtec may have a place in our treatment protocol.
Cranial Nerve #5 (the Trigeminal Nerve) is starting to get a lot of attention in the dry eye world because it innervates the surface of the eye. We know that the chronic inflammation of dry eye can cause the nerves on the surface of the eye dropout or become abnormal causing NK or neurotrophic keratitis. Up until now, we have used targeted treatments for NK like platelet-rich plasma (PRP), intense pulsed light (IPL), repository corticotropin (Acthar), low dose naltrexone NLD and cenegermin (Oxervate). Now, we may have a new treatment to address dry eye and ocular surface disease caused by NK: Nurtec ODT (Rimegepant).
You might have seen Khloe Kardashian singing the praises of Nurtec ODT (Rimegepant) as their spokesperson. Approved in February 2020 right before COVID, it has quickly become the number one selling migraine medicine even with little or no sales team interaction during the pandemic. It dissolves in your mouth, takes 30 minutes to start working and one tablet works for a full 48 hours with little to no side effects. It is part of a family of new migraine medications called gepants and is a highly-selective, calcitonin gene-related peptide antagonist for the acute treatment and prevention of migraine and auras caused by migraine. This class of medications target CGRP signaling through either stimulation of 5-HT1f receptors on trigeminovascular nerves (resulting in inhibition of CGRP release) or direct blockade of CGRP or its receptor, basically soothing irritated nerves from migraine or dry eye.
CGRP has been connected to both ocular pain and corneal epithelial repair. Research suggests that both dry eye symptoms and migraine pain are driven in part by central sensitization in the brain. DED patients with allodynia, pain caused by stimulus that does not normally elicit pain, can be the toughest patients to treat. For example, we have had patients complain of debilitating pain just by feeling a breeze when going outside. Corneal nerves project (even when not physically connected) to the trigeminal brainstem region and both dry eye and migraineurs have central nerve abnormalities. Acute and chronic inflammation is known to be an important feature of dry eye and CGRP is a neuropeptide known to act by soothing neurogenic inflammation.
We will be utilizing the Toyos Nurtec protocol for dry eye in our upcoming research study. If you’d like more information on Nurtec ODT for dry eye disease, schedule an appointment at Toyos Clinic in Memphis, Nashville and New York City. If you have tough to treat dry eye and/or migraines, Nurtec ODT may be right for you. Call 615.327.4015 to schedule an appointment to learn more.