Lasmiditan (Reyvow) has very high selectivity and affinity for 5-HT-1F receptors. It reduces neuronal transmission from the trigeminal system without causing vasoconstriction.
Lasmiditan (Reyvow) Uses:
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This medicine helps grown-ups with migraines feel better fast, whether they have warning signs (aura) or not.
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But it's not meant to stop migraines from happening in the first place.
Lasmiditan (Reyvow) Dose in Adults:
Note:
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If someone can't wait at least 8 hours between taking the medicine and driving or using heavy machinery, they shouldn't take it.
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Dose in the treatment of Migraine:
- You can take either 50, 100, or 200 mg of this medicine by mouth as a one-time dose.
- Don't take more than one dose within 24 hours.
- Also, we're not sure if it's safe to use this medicine for more than four migraine attacks in a month.
Dosage adjustment for concomitant therapy:
- There are important interactions with other drugs that might mean you need to take less of this medicine, use it less often, or stop using it altogether.
- I'll let you know about these interactions soon.
Dose in Children:
This medicine is not recommended for use in children.
Pregnancy Risk Category: N (Not assigned)
- Animal reproduction studies have shown negative outcomes for the fetus when this medicine is used.
Use during breastfeeding
- It's uncertain whether the drug passes into breast milk.
- Manufacturers suggest carefully considering the advantages and disadvantages of using the medication for both the mother and the infant.
Dose in Kidney disease:
There's no need to change the dosage.
Dose in Liver disease:
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For mild to moderate liver problems (Child-Pugh class A or B), you don't need to change the dose.
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But for severe liver issues (Child-Pugh class C), it's not recommended and hasn't been studied in people with advanced liver disease.
Common Side Effects of Lasmiditan (Reyvow):
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Central nervous system:
- Dizziness
Less Common Side Effects of Lasmiditan (Reyvow):
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Cardiovascular:
- Chest Discomfort
- Palpitations
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Central Nervous System:
- Paresthesia
- Drowsiness
- Fatigue
- Abnormal Dreams
- Anxiety
- Ataxia
- Cognitive Dysfunction
- Confusion
- Euphoria
- Feeling Abnormal
- Hallucination
- Lethargy
- Local Discomfort
- Restlessness
- Sleep Disturbance
- Speech Disturbance
- Vertigo
- Myasthenia
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Gastrointestinal:
- Nausea
- Vomiting
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Neuromuscular & Skeletal:
- Muscle Spasm
- Tremor
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Ophthalmic:
- Visual Impairment
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Respiratory:
- Dyspnea
Frequency of side effects not defined:
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Cardiovascular:
- Decreased heart rate
- Increased blood pressure
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Central nervous system:
- Central nervous system depression
Contraindications to Lasmiditan (Reyvow):
- The manufacturer's instructions don't list any reasons why you shouldn't use this medicine.
Warnings and precautions
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Depression in the CNS:
- This medicine can affect the central nervous system, potentially causing mental and physical impairment.
- To stay safe, don't drive during the eight hours after taking it.
- If you can't avoid activities that need mental alertness for more than eight hours after taking the medicine, don't take it.
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Serotonin syndrome
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Serotonin syndrome can be a serious issue for patients taking this medicine, whether they're using it alone or with other drugs that affect serotonin levels.
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These other drugs could include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine, triptans like zolmitriptan, tricyclic antidepressants like amitriptyline, tramadol, or lithium.
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Serotonin syndrome can lead to mental changes, neuromuscular symptoms, and seizures, so patients need close monitoring.
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If you notice any signs of serotonin syndrome, stop the treatment right away and seek appropriate medical help.
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Cardiovascular disease
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This medicine might cause slow heart rate (bradycardia) or low blood pressure when standing up (systolic hypotension).
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It's not recommended for people with existing heart problems.
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Hepatic impairment
- Patients with significant liver problems should avoid taking this medication.
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For the elderly:
- Elderly patients may feel dizzy or have low blood pressure when standing up (systolic hypotension).
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Use it in the right way:
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This medicine isn't recommended for preventing or treating migraine attacks.
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Also, using drugs like opioids, triptans, or ergotamine to stop migraines more than 10 times a month might lead to medication overuse headaches.
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Lasmiditan: Drug Interaction
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Alcohol (Ethyl) |
CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). |
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Alizapride |
May enhance the CNS depressant effect of CNS Depressants. |
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Bradycardia-Causing Agents |
May enhance the bradycardic effect of other Bradycardia-Causing Agents. |
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Brexanolone |
CNS Depressants may enhance the CNS depressant effect of Brexanolone. |
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Brimonidine (Topical) |
May enhance the CNS depressant effect of CNS Depressants. |
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Bromopride |
May enhance the CNS depressant effect of CNS Depressants. |
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Cannabidiol |
May enhance the CNS depressant effect of CNS Depressants. |
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Cannabis |
May enhance the CNS depressant effect of CNS Depressants. |
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Chlorphenesin Carbamate |
May enhance the adverse/toxic effect of CNS Depressants. |
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CNS Depressants |
Other CNS depressants' harmful or toxic effects might be exacerbated. |
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Dimethindene (Topical) |
Other CNS depressants' harmful or toxic effects might be exacerbated. |
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Doxylamine |
Other CNS depressants' harmful or toxic effects might be exacerbated. |
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Dronabinol |
Other CNS depressants' harmful or toxic effects might be exacerbated. |
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Esketamine |
Other CNS depressants' harmful or toxic effects might be exacerbated. |
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HydrOXYzine |
Other CNS depressants' harmful or toxic effects might be exacerbated. |
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Ivabradine |
Bradycardia-Causing Agents may intensify Ivabradine's bradycardic impact. |
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Kava Kava |
Other CNS depressants' harmful or toxic effects might be exacerbated. |
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Lacosamide |
Bradycardia-Causing Substances may intensify Lacosamide's AV-blocking effects. |
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Lofexidine |
May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs. |
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Magnesium Sulfate |
May enhance the CNS depressant effect of CNS Depressants. |
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MetyroSINE |
CNS Depressants may enhance the sedative effect of MetyroSINE. |
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Midodrine |
May enhance the bradycardic effect of Bradycardia-Causing Agents. |
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Minocycline (Systemic) |
May enhance the CNS depressant effect of CNS Depressants. |
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Nabilone |
May enhance the CNS depressant effect of CNS Depressants. |
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Piribedil |
CNS Depressants may enhance the CNS depressant effect of Piribedil. |
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Pramipexole |
CNS Depressants may enhance the sedative effect of Pramipexole. |
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ROPINIRole |
The sedative effects of CNS depressants may increase those of ROPINIRole. |
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Rotigotine |
Rotigotine's sedative effects may be boosted by CNS depressants. |
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Rufinamide |
CNS depressants' harmful or toxic effects could be increased. Particularly, drowsiness and lightheadedness could be worsened. |
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Ruxolitinib |
Bradycardia-Causing Agents' bradycardic effect might be enhanced. Management: The Canadian product labelling for roxolitinib advises against using it in conjunction with medications that can cause bradycardia whenever feasible. |
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Serotonergic Agents (High Risk) |
Serotonergic agents' serotonergic effects could be improved by lasmiditan (High Risk). Serotonin syndrome might occur from this. When these medications are taken together, it is important to watch out for any signs and symptoms of serotonin syndrome or serotonin poisoning, such as hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, and changes in mental status. |
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Terlipressin |
May enhance the bradycardic effect of Bradycardia-Causing Agents. |
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Tetrahydrocannabinol |
May enhance the CNS depressant effect of CNS Depressants. |
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Tetrahydrocannabinol and Cannabidiol |
May enhance the CNS depressant effect of CNS Depressants. |
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Tofacitinib |
May enhance the bradycardic effect of Bradycardia-Causing Agents. |
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Trimeprazine |
May enhance the CNS depressant effect of CNS Depressants. |
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Risk Factor D (Consider therapy modification) |
|
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Blonanserin |
CNS Depressants may enhance the CNS depressant effect of Blonanserin. |
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Buprenorphine |
|
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Chlormethiazole |
May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. |
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Droperidol |
May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs. |
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Flunitrazepam |
CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. |
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HYDROcodone |
CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
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Lemborexant |
CNS depressants may have an enhanced CNS depressant impact. Management: Due to the possibility of additive CNS depressant effects when lemborexant and concurrent CNS depressants are administered concurrently, dosage modifications may be required. Effects of CNS depressants must be closely monitored. |
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Methotrimeprazine |
The CNS depressing action of methotrimeprazine may be enhanced by CNS depressants. The CNS depressant action of CNS Depressants may be strengthened by methotrimeprazine. Management: Start concurrent methotrimeprazine therapy while reducing the adult dose of CNS depressants by 50%. Only once a clinically effective dose of methotrimeprazine has been established should additional CNS depressant dosage modifications be made. |
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Opioid Agonists |
Opioid agonists' CNS depressing effects may be amplified by CNS depressants. Management: When at all possible, refrain from using benzodiazepines or other CNS depressants concurrently with opioid agonists. Only in the event that other treatment choices are insufficient should these medications be combined. Limit the duration and dosage of each medicine when used together. |
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OxyCODONE |
CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
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Perampanel |
May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. |
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Siponimod |
Bradycardia-Causing Agents may intensify Siponimod's bradycardic impact. Management: Steer clear of combining siponimod with medications that can slow your heart rate. |
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Sodium Oxybate |
CNS depressants may have an enhanced CNS depressant impact. Management: Take into account substitutes for combined use. Reduce the doses of one or more medications when simultaneous use is necessary. It is not advised to use sodium oxybate with alcoholic beverages or hypnotic sedatives. |
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Suvorexant |
CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. |
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Tapentadol |
May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. |
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Zolpidem |
CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. |
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Risk Factor X (Avoid combination) |
|
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Azelastine (Nasal) |
Azelastine's CNS depressing impact may be amplified by CNS depressants (Nasal). |
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BCRP/ABCG2 Substrates |
The serum concentration of BCRP/ABCG2 Substrates may rise in response to lasmiditan. |
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Bromperidol |
CNS depressants may have an enhanced CNS depressant impact. |
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Fexinidazole [INT] |
Bradycardia-Causing Agents may intensify Fexinidazole's [INT] ability to induce arrhythmias. |
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Orphenadrine |
The CNS depressing action of orphenadrine may be enhanced by CNS depressants. |
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Oxomemazine |
CNS depressants may have an enhanced CNS depressant impact. |
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Paraldehyde |
The CNS depressing effects of paraldehyde may be enhanced by CNS depressants. |
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P-glycoprotein/ABCB1 Substrates |
Pglycoprotein/ABCB1 Substrates' serum levels may rise in response to lasmiditan. |
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Thalidomide |
The CNS depressing effect of thalidomide may be enhanced by CNS depressants. |
Monitoring parameters:
- Liver function tests should be done before starting the medication and as needed based on the patient's condition.
- Blood pressure and heart rate should be checked in patients with existing heart problems before starting the medication and as needed based on the patient's condition.
How to administer Lasmiditan (Reyvow)
You can take this medicine by mouth with or without food.
Mechanism of action of Lasmiditan (Reyvow):
- Lasmiditan attaches strongly and specifically to 5-HT-1F receptors.
- By doing so, it blocks these receptors, which lowers the activity of trigeminal systems.
- This can lead to relief from migraines and help prevent blood vessel narrowing (vasoconstriction).
- Onset of action: It typically starts working within 30 to 60 minutes after taking doses of 100 or 200 mg. It's quite fast.
- Protein binding: Around 55% to 60% of the medication attaches to proteins in the blood.
- Metabolism: The liver and other parts of the body break down the medication using enzymes that aren't CYP enzymes.
- Half-life elimination: It takes about 5.7 hours for half of the medication to leave the body.
- Time to peak: The highest concentration of the medication in the blood occurs around 1.8 hours after taking it.
- Excretion: About 66% of the drug leaves the body through urine, with only around 3% unchanged.
Lasmiditan Brands Names International:
- Reyvow
Lasmiditan Brands Names in Pakistan:
No Brands Available in Pakistan.
