Lasmiditan

Lasmiditan Brand Name– REYVOW

What is Lasmiditan

Lasmiditan is an oral serotonin receptor 5-HT_1F agonist indicated for acute treatment of migraine with or without aura in adults.

In 2 randomized, double-blind, placebo-controlled trials, lasmiditan (n = 3,743) significantly increased freedom from pain and bothersome migraine symptoms (i.e., photophobia, phonophobia, or nausea) at 2 hours.

When compared to placebo, pain freedom at 2 hours occurred in more lasmiditan-treated patients; the differences in pain freedom at 2 hours between lasmiditan and placebo groups were 7.3% for lasmiditan 50 mg (p less than 0.006), 10.4% and 13% for lasmiditan 100 mg (p less than 0.001), and 16.5% and 17.8% for lasmiditan 200 mg (p less than 0.001).

Additionally, lasmiditan alleviated bothersome migraine symptoms at 2 hours in significantly more patients; the differences in most bothersome symptom freedom at 2 hours between lasmiditan and placebo groups were 7.6% for lasmiditan 50 mg (p = 0.014), 10.8% and 11.6% for lasmiditan 100 mg (p less than 0.001), and 11.1% and 15.5% for lasmiditan 200 mg (p less than 0.001).

Lasmiditan may cause CNS depression and significant driving impairment. Potentially hazardous activities requiring complete mental alertness, such as driving or operating machinery, must be avoided for at least 8 hours after each dose of lasmiditan.

Lasmiditan does not activate 5-HT_1B receptors in peripheral blood vessels, including coronary arteries, and does not induce vasoconstriction.

Indications

• migraine

Guideline indications for initiating acute migraine treatment with lasmiditan: 

• Contraindications to the use of serotonin-receptor agonists (“triptans”) or
• Failure to respond to or tolerate at least 2 oral triptans, as determined by either health care provider attestation or a validated acute treatment patient-reported outcome questionnaire (e.g., Migraine Treatment Optimization Questionnaire [mTOQ], Migraine Assessment of Current Therapy [Migraine-ACT], Patient Perception of Migraine Questionnaire-Revised [PPMQ-R], Functional Impairment Scale [FIS], Patient Global Impression of Change [PGIC])

Side Effects

1. abnormal dreams
2. angioedema
3. anxiety
4. asthenia
5. confusion
6. dizziness
7. drowsiness
8. dyspnea
9. euphoria
10. fatigue
11. hallucinations
12. headache
13. hypoesthesia
14. lethargy
15. malaise
16. nausea
17. palpitations
18. paresthesias
19. photosensitivity
20. rash
21. restlessness
22. serotonin syndrome
23. tremor
24. vertigo
25. visual impairment
26. vomiting
27. weakness

Monitoring Parameters

• laboratory monitoring not necessary

Contraindications

• breast-feeding
• cardiac disease
• driving or operating machinery
• hepatic disease
• pregnancy

Interactions

• Acebutolol
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Diphenhydramine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Tramadol
• Acrivastine; Pseudoephedrine
• Alfentanil
• Aliskiren; Amlodipine
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Almotriptan
• Alprazolam
• Amitriptyline
• Amitriptyline; Chlordiazepoxide
• Amlodipine
• Amlodipine; Atorvastatin
• Amlodipine; Benazepril
• Amlodipine; Celecoxib
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amlodipine; Olmesartan
• Amlodipine; Telmisartan
• Amlodipine; Valsartan
• Amobarbital
• Amoxapine
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• Amphetamines
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• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Oxycodone
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• Brompheniramine; Hydrocodone; Pseudoephedrine
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• Carbetapentane; Phenylephrine; Pyrilamine
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• Carbidopa; Levodopa
• Carbidopa; Levodopa; Entacapone
• Carbinoxamine
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• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
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• Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
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• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydromorphone
• Hydroxyzine
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Ibuprofen; Oxycodone
• Iloperidone
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• Ketamine
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• Meclizine
• Melatonin
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• Meperidine; Promethazine
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• Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
• Methocarbamol
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• Methylene Blue
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• Metoprolol
• Midazolam
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• Mirtazapine
• Molindone
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• Morphine; Naltrexone
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• Nimodipine
• Nisoldipine
• Nortriptyline
• Olanzapine
• Ondansetron
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• Oxazepam
• Oxycodone
• Oxymorphone
• Ozanimod
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• Pentazocine
• Pentazocine; Naloxone
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• Perampanel
• Perindopril; Amlodipine
• Perphenazine
• Perphenazine; Amitriptyline
• Phenelzine
• Phenobarbital
• Pimavanserin
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• Pindolol
• Pramipexole
• Pregabalin
• Primidone
• Prochlorperazine
• Propofol
• Propranolol
• Protriptyline
• Quazepam
• Quetiapine
• Ramelteon
• Rasagiline
• Remifentanil
• Rimegepant
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• Rizatriptan
• Ropinirole
• Rotigotine
• Safinamide
• Scopolamine
• Secobarbital
• Sedating H1-blockers
• Selective serotonin reuptake inhibitors
• Selegiline
• Serotonin norepinephrine reuptake inhibitors
• Serotonin-Receptor Agonists
• Serotonin-Receptor Antagonists
• Sertraline
• Sevoflurane
• Sodium Oxybate
• Sotalol
• St. John’s Wort, Hypericum perforatum
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• Tetrabenazine
• Thalidomide
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• Tizanidine
• Tolcapone
• Tramadol
• Trandolapril; Verapamil
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