lasmiditan (Rx)

Brand and Other Names:Reyvow
  • Print

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 50mg
  • 100mg

Acute Migraine

Indicated for treatment of acute migraine with or without aura

50 mg, 100 mg, or 200 mg PO PRN

Not to exceed more than 1 dose/24 hr

Do not take unless patient can wait at least 8 hr between dosing and driving or operating machinery

Second dose has not been shown to be effective for the same migraine attack

The safety of treating an average of >4 migraine attacks/30 days has not been established

Dosage Modifications

Renal impairment

  • No dosage adjustment needed for any degree of renal impairment

Hepatic impairment

  • Mild or moderate (Child-Pugh A or B): No dosage adjustment needed
  • Severe (Child-Pugh C): Not recommended

Dosing Considerations

Limitations of use

  • Not indicated for prevention of migraine

Safety and efficacy not established

Acute Migraine

Indicated for treatment of acute migraine with or without aura

50 mg, 100 mg, or 200 mg PO PRN; initiate at lower end of dosage range for geriatric patients

Not to exceed more than 1 dose/24 hr

Do not take unless patient can wait at least 8 hr between dosing and driving or operating machinery

Second dose has not been shown to be effective for the same migraine attack

The safety of treating an average of >4 migraine attacks/30 days has not been established

Dosage Modifications

Renal impairment

  • No dosage adjustment needed for any degree of renal impairment

Hepatic impairment

  • Mild or moderate (Child-Pugh A or B): No dosage adjustment needed
  • Severe (Child-Pugh C): Not recommended

Dosing Considerations

Generally start dose at low end of dosing range for geriatric patients

Dizziness occurred more frequently in patients aged >65 yr (19% vs 2% for placebo) compared with patients aged <65 yr (14% vs 3% for placebo)

A larger increase in systolic blood pressure also occurred in patients aged >65 yr compared with those aged <65 yr

Limitations of use

  • Not indicated for prevention of migraine
Next:

Interactions

Interaction Checker

and lasmiditan

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 
            Previous
            Next:

            Adverse Effects

            >10%

            Dizziness (9-17%)

            1-10%

            Paresthesia (3-9%)

            Sedation (6-7%)

            Fatigue (4-6%)

            Nausea and/or vomiting (3-4%)

            Muscle weakness (1-2%)

            <2%

            • Vertigo
            • Incoordination
            • Lethargy
            • Visual impairment
            • Feeling abnormal
            • Palpitations
            • Anxiety
            • Tremor
            • Restlessness
            • Sleep abnormalities (eg, sleep disturbance, abnormal dreams)
            • Muscle spasm
            • Limb discomfort
            • Cognitive changes
            • Confusion
            • Euphoric mood
            • Chest discomfort
            • Speech abnormalities
            • Dyspnea
            • Hallucinations

            <1%

            Hypersensitivity (eg, angioedema, rash, photosensitivity reaction)

            Previous
            Next:

            Warnings

            Contraindications

            None

            Cautions

            Significant driving impairment may occur; advise patients not to engage in potentially hazardous activities requiring complete mental alertness eg, driving a motor vehicle, operating machinery) for at least 8 hr after each dose; avoid use in patients who are unable to follow this advice

            Reactions consistent with serotonin syndrome reported; discontinue if symptoms of serotonin syndrome occur

            CNS depression (eg, dizziness, sedation) reported

            Overuse of acute migraine drugs (eg, ergotamines, triptans, opioids, or a combination of these drugs for ≥10 per month) may lead to exacerbation of headache (ie, medication overuse headache); may present as migrainelike daily headaches or as a marked increase in frequency of migraine attacks; detoxification and treatment of withdrawal symptoms (which often includes a transient worsening of headache) may be necessary

            Drug interaction overview

            • Lasmiditan inhibits P-gp and breast cancer-resistant protein (BCRP); avoid coadministration
            • Owing to the potential for sedation, other cognitive and/or neuropsychiatric adverse reactions, and driving impairment, use with caution if used in combination with alcohol or other CNS depressants
            • Coadministration of lasmiditan and drugs (eg, SSRIs, SNRIs, TCAs, MAO inhibitors, trazodone), over-the-counter medications (eg, dextromethorphan), or herbal supplements (eg, St. John’s wort) that increase serotonin may increase the risk of serotonin syndrome; use with caution in patients taking medications that increase serotonin.
            • In a drug interaction study, addition of a single lasmiditan 200-mg dose to propranolol decreased heart rate by an additional 5 bpm compared with propranolol alone, for a mean maximum of 19 bpm; use with caution in patients taking concomitant medications that lower heart rate
            Previous
            Next:

            Pregnancy & Lactation

            Pregnancy

            No adequate data are available on the developmental risk associated with use in pregnant women

            Clinical considerations

            • Data suggest women with migraine may be at increased risk for preeclampsia and gestational hypertension during pregnancy

            Animal data

            • In animal studies, adverse effects on development (increased incidences of fetal abnormalities, increased embryofetal and offspring mortality, decreased fetal body weight) occurred at maternal exposures less than (rabbit) or greater than (rat) those observed clinically

            Lactation

            There are no data on the presence in human milk, effects on breastfed infants, or effects on milk production

            Excretion of lasmiditan and/or metabolites into milk, at levels ~3 times those in maternal plasma, was observed in lactating rats following oral administration

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

            Previous
            Next:

            Pharmacology

            Mechanism of Action

            Lasmiditan binds with high affinity to the 5-HT1F receptor; it presumably exerts its therapeutic effects for acute migraine through agonist effects at the 5-HT1F receptor; however, the precise mechanism is unknown

            Serotonin 5-HT1F agonists (ie, ditans) do not elicit a vasoconstrictive effect

            Absorption

            Peak plasma time: 1.8 hr

            Distribution

            Protein bound: 55-60%

            Metabolism

            Undergoes hepatic and extrahepatic metabolism primarily by non-CYP enzymes

            Also metabolized to M7 (oxidation on piperidine ring) and M18 (combination of M7 and M8 pathways); these metabolites are considered pharmacologically inactive

            Elimination

            Half-life: 5.7 hr

            Primarily eliminated via metabolism, with ketone reduction representing the major pathway

            Excretion: Urine (3% [unchanged], ~66% [metabolite S-M8])

            Previous
            Next:

            Administration

            Oral Administration

            May take with or without food

            Storage

            Store at 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF)

            Previous
            Next:

            Images

            Previous
            Next:

            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.