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:
- It is prescribed for the quick relief of adult migraine sufferers, aura or not. It is not indicated for the prevention of migraine attacks.
Lasmiditan (Reyvow) Dose in Adults:
Note:
- If the patient can not wait for at least 8 hours between the dose and operating heavy machinery or driving, avoid administering the drug.
-
Dose in the treatment of Migraine:
- 50, 100, or 200 mg orally as a single dose.
- The maximum dose is one dose in 24 hours.
- The safety of treating greater than four migraine attacks per month has not been evaluated.
Dosage adjustment for concomitant therapy:
- Significant drug interactions exist that may require reducing the dose, frequency, or discontinuation of the drug.
- Drug interactions will be posted later.
Dose in Children:
Not indicated. [
Pregnancy Risk Category: N (Not assigned)
- Negative fetal outcomes have been documented in animal reproduction studies.
Use during breastfeeding
- It is unknown if the drug will be excreted into breastmilk.
- Manufacturers recommend that you weigh the benefits and risks of drug therapy for the infant and mother.
Dose in Kidney disease:
No dosage adjustment is necessary.
Dose in Liver disease:
- Mild or moderate impairment (Child-Pugh class A or B):
- Adjustment in the dose is not necessary.
- Severe hepatic impairment (Child-Pugh class C):
- It is not advised and has not been researched in people with advanced liver disease.
Common Side Effects of Lasmiditan (Reyvow):
-
Central nervous system:
- Dizziness
Less Common Side Effects of Lasmiditan (Reyvow):
-
Cardiovascular:
- Chest Discomfort
- Palpitations
-
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
-
Gastrointestinal:
- Nausea
- Vomiting
-
Neuromuscular & Skeletal:
- Muscle Spasm
- Tremor
-
Ophthalmic:
- Visual Impairment
-
Respiratory:
- Dyspnea
Frequency of side effects not defined:
-
Cardiovascular:
- Decreased heart rate
- Increased blood pressure
-
Central nervous system:
- Central nervous system depression
Contraindications to Lasmiditan (Reyvow):
- The manufacturer's labeling does not contain any contraindications.
Warnings and precautions
-
Depression in the CNS:
- It can cause depression in the central nervous system, which could lead to impairment of mental and physical abilities.
- Patients are not allowed to drive during the eight-hour period of drug administration.
- Do not consume the drug if you are unable to avoid any activities that require mental alertness for more than 8 hours after the intake.
-
Serotonin syndrome
- Serotonin syndrome can be a serious condition in patients who take the drug.
- This may be with or without concomitant use other serotoninrgic agents, such as (selective Serotonin Reuptake Inhibitors, serotonin–norepinephrine Reuptake Inhibitors such as duloxetine), triptans such as zolmitriptan or tricyclic antidepressants such as amitryptaline or tramadol or lithium.
- Serotonin syndrome is a clinical condition that can cause mental changes, neuromuscular symptoms and seizures. Patients should be closely monitored.
- If you notice any clinical signs of serotonin disorder, stop the treatment immediately and take appropriate steps.
-
Cardiovascular disease
-
There could be bradycardia or systolic hypotension. It shouldn't be used by people with heart disease who already have it.
-
-
Hepatic impairment
- A significant hepatic impairment should prevent a patient from taking the medication.
-
For the elderly:
- Patients in their old age may experience dizziness or systolic hypotension.
-
Use it in the right way:
- For the prevention or treatment of migraine attacks, this medication is not advised.
- Patients who use drugs to stop migraine attacks (such as opioids, triptans, or ergotamine) more than 10 times per month may experience medication overuse headaches.
Lasmiditan: Drug Interaction
|
Alcohol (Ethyl) |
CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). |
|
Alizapride |
May enhance the CNS depressant effect of CNS Depressants. |
|
Bradycardia-Causing Agents |
May enhance the bradycardic effect of other Bradycardia-Causing Agents. |
|
Brexanolone |
CNS Depressants may enhance the CNS depressant effect of Brexanolone. |
|
Brimonidine (Topical) |
May enhance the CNS depressant effect of CNS Depressants. |
|
Bromopride |
May enhance the CNS depressant effect of CNS Depressants. |
|
Cannabidiol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Cannabis |
May enhance the CNS depressant effect of CNS Depressants. |
|
Chlorphenesin Carbamate |
May enhance the adverse/toxic effect of CNS Depressants. |
|
CNS Depressants |
Other CNS depressants' harmful or toxic effects might be exacerbated. |
|
Dimethindene (Topical) |
Other CNS depressants' harmful or toxic effects might be exacerbated. |
|
Doxylamine |
Other CNS depressants' harmful or toxic effects might be exacerbated. |
|
Dronabinol |
Other CNS depressants' harmful or toxic effects might be exacerbated. |
|
Esketamine |
Other CNS depressants' harmful or toxic effects might be exacerbated. |
|
HydrOXYzine |
Other CNS depressants' harmful or toxic effects might be exacerbated. |
|
Ivabradine |
Bradycardia-Causing Agents may intensify Ivabradine's bradycardic impact. |
|
Kava Kava |
Other CNS depressants' harmful or toxic effects might be exacerbated. |
|
Lacosamide |
Bradycardia-Causing Substances may intensify Lacosamide's AV-blocking effects. |
|
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. |
|
Magnesium Sulfate |
May enhance the CNS depressant effect of CNS Depressants. |
|
MetyroSINE |
CNS Depressants may enhance the sedative effect of MetyroSINE. |
|
Midodrine |
May enhance the bradycardic effect of Bradycardia-Causing Agents. |
|
Minocycline (Systemic) |
May enhance the CNS depressant effect of CNS Depressants. |
|
Nabilone |
May enhance the CNS depressant effect of CNS Depressants. |
|
Piribedil |
CNS Depressants may enhance the CNS depressant effect of Piribedil. |
|
Pramipexole |
CNS Depressants may enhance the sedative effect of Pramipexole. |
|
ROPINIRole |
The sedative effects of CNS depressants may increase those of ROPINIRole. |
|
Rotigotine |
Rotigotine's sedative effects may be boosted by CNS depressants. |
|
Rufinamide |
CNS depressants' harmful or toxic effects could be increased. Particularly, drowsiness and lightheadedness could be worsened. |
|
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. |
|
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. |
|
Terlipressin |
May enhance the bradycardic effect of Bradycardia-Causing Agents. |
|
Tetrahydrocannabinol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Tetrahydrocannabinol and Cannabidiol |
May enhance the CNS depressant effect of CNS Depressants. |
|
Tofacitinib |
May enhance the bradycardic effect of Bradycardia-Causing Agents. |
|
Trimeprazine |
May enhance the CNS depressant effect of CNS Depressants. |
|
Risk Factor D (Consider therapy modification) |
|
|
Blonanserin |
CNS Depressants may enhance the CNS depressant effect of Blonanserin. |
|
Buprenorphine |
|
|
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. |
|
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. |
|
Flunitrazepam |
CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. |
|
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. |
|
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. |
|
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. |
|
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. |
|
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. |
|
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. |
|
Siponimod |
Bradycardia-Causing Agents may intensify Siponimod's bradycardic impact. Management: Steer clear of combining siponimod with medications that can slow your heart rate. |
|
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. |
|
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. |
|
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. |
|
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. |
|
Risk Factor X (Avoid combination) |
|
|
Azelastine (Nasal) |
Azelastine's CNS depressing impact may be amplified by CNS depressants (Nasal). |
|
BCRP/ABCG2 Substrates |
The serum concentration of BCRP/ABCG2 Substrates may rise in response to lasmiditan. |
|
Bromperidol |
CNS depressants may have an enhanced CNS depressant impact. |
|
Fexinidazole [INT] |
Bradycardia-Causing Agents may intensify Fexinidazole's [INT] ability to induce arrhythmias. |
|
Orphenadrine |
The CNS depressing action of orphenadrine may be enhanced by CNS depressants. |
|
Oxomemazine |
CNS depressants may have an enhanced CNS depressant impact. |
|
Paraldehyde |
The CNS depressing effects of paraldehyde may be enhanced by CNS depressants. |
|
P-glycoprotein/ABCB1 Substrates |
Pglycoprotein/ABCB1 Substrates' serum levels may rise in response to lasmiditan. |
|
Thalidomide |
The CNS depressing effect of thalidomide may be enhanced by CNS depressants. |
Monitoring parameters:
- Liver function tests at baseline and as clinically indicated,
- BP, and heart rate in patients with preexisting cardiovascular disease at baseline and as clinically indicated.
How to administer Lasmiditan (Reyvow)
It may be administered with or without food orally.
Mechanism of action of Lasmiditan (Reyvow):
- Lasmiditan selectively and with great affinity binds to 5-HT-1F receptors.
- Lasmiditan inhibits these receptors, which reduces the activation of the trigeminal systems. Both migraine relief and vasoconstriction prevention are possible with it.
The onset of action:
- 30 to 60 minutes (100 and 200 mg doses).
- Rapid.
Protein binding:
- ~55% to 60%.
Metabolism:
- It is metabolized by non-CYP enzymes of the liver and extrahepatic.
Half-life elimination:
- About 5.7 hours.
Time to peak:
- 1.8 hours.
Excretion:
- About 66% of the drug is excreted in urine (~3% as unchanged drug).
Lasmiditan Brands Names International:
- Reyvow
Lasmiditan Brands Names in Pakistan:
No Brands Available in Pakistan.
.png)
