Lasmiditan

Lasmiditan Brand Name– REYVOW

What is Lasmiditan

Lasmiditan is an oral serotonin receptor 5-HT1F 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-HT1B 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
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  • Amlodipine
  • Amlodipine; Atorvastatin
  • Amlodipine; Benazepril
  • Amlodipine; Celecoxib
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  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amlodipine; Olmesartan
  • Amlodipine; Telmisartan
  • Amlodipine; Valsartan
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  • Asenapine
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  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
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  • Aspirin, ASA; Oxycodone
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  • Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
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  • Guanfacine
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  • Halothane
  • Homatropine; Hydrocodone
  • Hydrochlorothiazide, HCTZ; Methyldopa
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydromorphone
  • Hydroxyzine
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
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  • Naratriptan
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  • Ondansetron
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  • Oxazepam
  • Oxycodone
  • Oxymorphone
  • Ozanimod
  • Paliperidone
  • Palonosetron
  • Paroxetine
  • Penbutolol
  • Pentazocine
  • Pentazocine; Naloxone
  • Pentobarbital
  • Perampanel
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  • Perphenazine
  • Perphenazine; Amitriptyline
  • Phenelzine
  • Phenobarbital
  • Pimavanserin
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