Ajovy (Fremanezumab-vfrm) – Subcutaneous

What Is Ajovy?

Ajovy (fremanezumab-vfrm) is a monoclonal antibody prescribed to prevent migraines in adults.

As a calcitonin gene-related peptide (CGRP) inhibitor, Ajovy works by blocking the effects of the CGRP protein. This protein is released in your nervous system during a severe migraine attack.

Ajovy is given as an injection underneath the skin (subcutaneous) once a month or once every three months.

Drug Facts

Generic Name: Fremanezumab-vfrm

Brand Name(s): Ajovy

Drug Availability: Prescription

Therapeutic Classification: Antimigraine
Available Generically: No

Controlled Substance: N/A

Administration Route: Subcutaneous

Active Ingredient: Fremanezumab

Dosage Form(s): Subcutaneous injection in prefilled syringe or autoinjector

What Is Ajovy Used For?

Ajovy is used to prevent (not treat) migraines in adults. Migraine is a neurological condition that causes throbbing or pounding headaches that are intense, debilitating, and often associated with other symptoms, like nausea, vomiting, and sensitivity to light, sound, and/or smells.

Ajovy Dug information - Illustration by Zoe Hansen

Verywell / Zoe Hansen

How to Take Ajovy

Ajovy may be given in one of two dosing schedules:

  • A single 225 milligram (mg) injection once a month 
  • Three 225 mg injections (for a total of 675 mg) taken on the same day once every three months

Ajovy comes as a prefilled single-dose syringe or an autoinjector (with no visible needle). You can give yourself the injection at home or have a caregiver or healthcare provider administer it. If you (or a caregiver) decide to perform the injections, your healthcare provider will teach you how to do it properly.

If you are giving yourself the injections, read the manufacturer's detailed instructions and watch a step-by-step video on how to inject the medicine.

A summary of the steps includes the following:

Preparation for Prefilled Syringe Injection

  • Remove one or three prefilled syringes from the medication carton, depending on your dosing schedule. 
  • Wait 30 minutes for the prefilled syringe(s) to reach room temperature. Keep the syringes out of direct sunlight, and do not use a heat source (e.g., microwave or hot water) to warm up the prefilled syringe. 
  • During the 30-minute waiting period, gather your alcohol swabs and cotton balls or gauze pads and place them on a clean, flat surface. 
  • When the 30 minutes are up, wash your hands with soap and water and dry well. 
  • Check that the liquid in the prefilled Ajovy syringe is clear and colorless or faintly yellow. If the liquid changes color or is cloudy, do not use it, and call your provider.
  • Keep in mind that air bubbles in the syringe are OK. Do not remove the air bubbles—injecting the medicine with air bubbles is not harmful.

Choosing an Injection Site

  • Choose a fatty area of skin on your body to inject—your stomach, the front of your thigh, or the back of your upper arm. 
  • Be sure not to inject into any skin area that is tender, red, bruised, calloused, tattooed, hard, or has scars or stretch marks. Also, avoid injecting in areas where other medications (e.g., insulin) have been injected. 
  • If you are giving yourself three shots (the 675 mg dose), you can inject in the same general area on your body, just not in the exact spot.
  • Clean the chosen area with a fresh alcohol swab. Wait 10 seconds for it to dry before injecting.

Injection of Ajovy

For the prefilled syringe:

  • Pick up the prefilled syringe in one hand. Using your other hand, pull the needle cap straight off and throw it away. To prevent infection, be sure to not touch the needle.
  • Use your free hand to gently pinch up at least 1 inch of cleaned skin. Insert the needle at a 45- to 90-degree angle.
  • When the needle is all the way into your skin, use your thumb to slowly push the plunger down, as far as it will go. 
  • Once you have injected all of the medicine, pull the needle straight out. To avoid injury or infection, do not put the cap back on the needle.
  • Gently apply gauze or a dry cotton ball for a few seconds to the injection site.

The directions for handling and using the autoinjector are similar to those for the prefilled syringe. However, there are a few differences.

For the autoinjector:

  • Uncap the autoinjector by pulling the cap straight off without twisting, and throw away the cap right away.
  • Place the autoinjector at a 90-degree angle on your cleaned skin at one of the injection sites.
  • When administering, press down on the applicator for 30 seconds to give the entire dose. You should hear a click when you start the injection and again at around 15 seconds into the injection. After the second click is heard, hold the needle in place for about 10 more seconds.

Disposal of Syringes and Autoinjectors

  • Put your used syringe and autoinjector in an FDA-cleared sharps disposal container. You can obtain one from your local pharmacy, healthcare provider, online, or through a medical supply company. Never throw your syringes in your household trash, and do not reuse any of the syringes. 
  • When your FDA-cleared sharps disposal container is full, follow your community or state laws for getting rid of it. Do not recycle your container. Talk with your provider if you have any questions.

Storage

You should store your Ajovy in its original container in a refrigerator at a temperature of 36 degrees to 46 degrees Fahrenheit. If you are traveling and do not have access to a refrigerator—you may store the drug at room temperature for up to seven days. If the drug is not used within seven days, throw it away. 

To avoid damaging the medicine, keep your Ajovy syringes away from extreme heat and direct sunlight. Also, do not freeze or shake the syringes. Keep the carton storing the Ajovy syringes out of reach of children and pets.

How Long Does Ajovy Take to Work?

Many people notice a benefit within one month of taking Ajovy. Nevertheless, it can take several months to see the drug’s full effect.

According to the American Headache Society, the benefit of CGRP inhibitors should be looked at after three months for those taking monthly injections and six months for those taking quarterly injections.

What Are the Side Effects of Ajovy?

This is not a complete list of side effects and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

The most common side effect of taking Ajovy is an injection site reaction around the area of the skin where the injection is given. Symptoms of an injection site reaction may include redness, pain, hardness, and/or swelling.

Severe Side Effects

Call your healthcare provider right away if you are experiencing severe side effects. Call 911 if your symptoms feel life-threatening, or if you think you’re having a medical emergency.

Ajovy may cause an allergic reaction within an hour or up to one month after receiving the shot. Rarely, a serious allergic reaction can occur.

Symptoms or signs of an allergic reaction to Ajovy may include:

  • Itching, rash, and hives
  • Red, swollen, blistered, or peeling skin, with or without fever
  • Wheezing 
  • Trouble breathing, swallowing, or talking
  • Chest or throat tightness
  • Unusual hoarseness
  • Swelling of your face, mouth, lips, tongue, or throat

Long-Term Side Effects

A very small number of patients taking Ajovy may develop antibodies to the drug itself. Early research indicates there is no apparent effect of these antibodies on the safety or benefit of Ajovy.

Report Side Effects

Ajovy may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Ajovy Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For injection dosage form (solution):
    • For migraine headaches:
      • Adults—225 milligrams (mg) injected under the skin once a month, or 675 mg injected under the skin every 3 months.
      • Children—Use and dose must be determined by your doctor.

Modifications

There are no specific Ajovy dosing adjustments for older adults (aged 65 years or older) or people with liver or kidney problems.

Tell your provider if you are pregnant or planning on becoming pregnant. While no developmental problems were seen in pregnant rats and rabbits given fremanezumab-vfrm in high doses, the effects of Ajovy in human pregnancy remain unknown.

Also, it’s not known if Ajovy passes into breast milk. Your provider should carefully review with you the risks and benefits of taking Ajovy while breastfeeding.

Missed Dose

If you miss a dose of your Ajovy, take the dose as soon as you remember. After taking the missed dose, you will have to start a new dosing schedule.

If you normally take 675 mg of Ajovy, you should inject your next set of three doses three months after the last set of doses. If you take 225 mg of Ajovy, inject your next dose one month after the previous dose.

Overdose: What Happens If I Take Too Much Ajovy?

Call a medical professional or the Poison Control center if you think you or someone else may have overdosed on Ajovy. Be ready to tell them how much of the drug was injected and when it happened.

What Happens If I Overdose on Ajovy?

If you think you or someone else may have overdosed on Ajovy, call a healthcare provider or the Poison Control Center (800-222-1222).

If you or someone you know has serious symptoms like passing out, trouble breathing, or facial swelling, go to your nearest emergency room or call 911.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to check for unwanted effects.

This medicine may cause serious allergic reactions, which can be life-threatening and require immediate medical attention. Tell your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth after using this medicine.

What Are Reasons I Shouldn’t Take Ajovy?

You should not take Ajovy if you have a known allergy or sensitivity to fremanezumab-vfrm or any of the medication’s ingredients.

People who are pregnant or have a history of heart attack or stroke should use Ajovy with caution or not at all. Tell your healthcare provider about your medical history before starting this medication. They can determine if Ajovy is a safe option for you.

What Medications May Interact With Ajovy?

Ajovy has not been found to interact with other medications. Yet, to be safe, tell your healthcare team all of the medications you are taking. This includes prescription and over-the-counter drugs, herbal products, supplements, vitamins, and recreational drugs.

What Medications Are Similar?

Besides Ajovy, there are four other CGRP inhibitors approved by the FDA for migraine prevention:

Aimovig and Emgality, like Ajovy, are given as injections underneath the skin. Aimovig is given once a month, whereas Emgality starts with a loading dose, followed by monthly doses.

Vyepti, on the other hand, is given intravenously (through your vein) every three months. 

Nurtec is a tablet that dissolves on your tongue (oral disintegrating tablet) and is taken every other day to prevent migraines. It was actually first approved as a treatment for existing migraines and later got approval for migraine prevention. 

Several other oral migraine preventive medications—called OMPMs—were used before the emergence of CGRP inhibitors. Examples include: 

Compared with OMPMs, CGRP inhibitors appeared to be more effective in reducing headache days per month, according to clinical studies.

If you and your provider decide to move forward with taking a CGRP inhibitor for migraine prevention, the choice will likely depend on factors such as availability and preference administration (e.g., taking a shot at home versus getting an infusion at a medical facility).

Frequently Asked Questions

  • How often do I take Ajovy?

    There are two dosing schedules—three 225-mg injections (total of 675 mg) taken on the same day once every three months or one 225-mg injection taken once a month. The shot can be done at home or your healthcare provider’s office.

  • Can I switch my Ajovy dosing schedules?

    You will need to talk with your provider first, but it is possible to switch to a different dosing schedule (every month to four times a year, or vice versa). When switching, you will want to take the first dose of Ajovy on the day it was due, based on your old schedule.

  • How fast can I expect to see results with Ajovy?

    Many people experience a benefit within one month, although it can take up to three to six months to see the drug’s full effect.

  • Can I take Ajovy with other migraine preventive medications?

    Yes. Research has found Ajovy to be safe and beneficial when used with other migraine preventive medications, including Botox (onabotulinumtoxin A). After starting Ajovy, keep in close touch with your healthcare team and attend all your appointments. At some point, your provider may decide to stop or reduce the dosage of your other migraine preventive drugs.

  • Is Ajovy safe for people with heart disease?

    When Ajovy and other similar drugs were emerging, there was a concern for people with underlying heart disease or risk factors for heart disease. CGRP dilates blood vessels. By blocking it, scientists were initially worried that vital organs, like the heart or brain, would not get adequate blood supply.

    This concern was somewhat eased by the results from a study of another CGRP inhibitor, erenumab. In this study, people with coronary artery disease who normally developed chest pain when exercising underwent an exercise stress test after receiving erenumab or a placebo. Results found no difference between the two groups in the time it took them to develop chest pain. Still, there have been no studies on the safety of fremanezumab-vfrm in people with significant heart disease. Tell your provider if you have a history of heart disease.

How Can I Stay Healthy While Taking Ajovy?

The approval of CGRP monoclonal antibodies has been an exciting milestone for migraine prevention. These drugs offer an alternative for preventing debilitating migraine attacks in patients not getting benefit from Botox or older, more classic drugs.

Nevertheless, the long-term safety of Ajovy and other CGRP monoclonal antibodies has not yet been established. Also, there is little scientific evidence to support using Ajovy, or other similar drugs, in certain people—older (aged 65 and above) or pregnant people.

As such, to optimize your health and stay safe, it's important to keep in regular touch with your neurologist while taking Ajovy. Attend all of your appointments and be open and honest about how well (or not) Ajovy is working. Also, tell your provider about any side effects you are having, and whether there are any changes in your overall health, including if you are pregnant or planning a pregnancy.

On a final note—continue to educate yourself about Ajovy. Try and keep up with the latest research on the drug. It’s important to be realistic, too. Ajovy and other CGRP monoclonal antibodies are far cries from migraine “cures.” They do offer hope, though, and may serve as a stepping stone to an even better migraine preventive drug.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. Ajovy: Highlights of Prescribing Information.

  2. Karsan N, Goadsby PJ. CGRP mechanism antagonists and migraine management. Curr Neurol Neurosci Rep. 2015 May;15(5):25. doi:10.1007/s11910-015-0547-z

  3. American Migraine Foundation. What Is Migraine?

  4. Gao B, Sun N, Yang Y, et al. Safety and efficacy of fremanezumab for the prevention of migraine: A meta-analysis from randomized controlled trials. Front Neurol. 2020 May 19;11:435. doi:10.3389/fneur.2020.00435

  5. American Headache Society. The American Headache Society position statement on integrating new migraine treatments into clinical practice. Headache. 2019 Jan;59(1):1-18. doi:10.1111/head.13456

  6. Cohen JM, Ning X, Kessler Y et al. Immunogenicity of biologic therapies for migraine: a review of current evidence. J Headache Pain. 2021 Jan 7;22(1):3. doi:10.1186/s10194-020-01211-5

  7. Robblee J, VanderPluym J. Fremanezumab in the treatment of migraines: evidence to date. J Pain Res. 2019; 12: 2589–2595. doi:10.2147/JPR.S166427

  8. Schwedt TJ, Garza I. UpToDate. Preventive treatment of episodic migraine in adults.

  9. Food and Drug Administration. Aimovig label.

  10. Food and Drug Administration. Emgality label.

  11. Food and Drug Administration. Vyepti label.

  12. Food and Drug Administration. Nurtec label.

  13. Institute for Clinical and Economic Review. Calcitonin gene-related peptide (CGRP) inhibitors as preventive treatments for patients with episodic or chronic migraine: effectiveness and value. July 3, 2018.

  14. Cohen JM, Dodick DW, Yang R et al. Fremanezumab as add-on treatment for patients treated with other migraine preventive medicines. Headache. 2017 Oct;57(9):1375-1384. doi:10.1111/head.13156

  15. Depre C, Antalik L, Starling A et al. A randomized, double-blind, placebo-controlled study to evaluate the effect of erenumab on exercise time during a treadmill test in patients with stable angina. Headache. 2018 May;58(5):715-723. doi:10.1111/head.13316

By Colleen Doherty, MD
 Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.