General

Pronunciation:
las-mid-i-tan

Trade Name(s)

• Reyvow

Ther. Class.

vascular headache suppressants

Pharm. Class.

five ht1 agonists

Controlled Substance Schedule: V

Indications

Acute treatment of migraine with or without aura.

Action

Acts as a selective agonist of 5-HT_1F  receptors, which decreases stimulation of the trigeminal system (without causing vasoconstriction).

Therapeutic Effect(s):

Relief of pain associated with acute migraine attacks.

Pharmacokinetics

Absorption: Rapidly absorbed. Absorption delayed by high-fat food.

Distribution: Unknown.

Metabolism and Excretion: Primarily metabolized by hepatic and nonhepatic pathways (by non-CYP enzymes) to inactive metabolites. Primarily excreted in urine as metabolites.

Half-life: 5.7 hr.

TIME/ACTION PROFILE (pain relief)

Contraindication/Precautions

Contraindicated in:

• Severe hepatic impairment.

Use Cautiously in:

• History of substance abuse;
• OB:   Use during pregnancy only if potential maternal benefit outweighs potential fetal risk;
• Lactation:  Use while breastfeeding only if potential maternal benefit outweighs potential risk to infant;
• Pedi:   Safety and effectiveness not established in children;
• Geri:   Use lowest dose possible in older adults (↑ risk for sedation and BP elevation).

Adverse Reactions/Side Effects

CV: ↓ heart rate, ↑ BP

GI: nausea, vomiting

MS: muscle weakness

Neuro: dizziness, drowsiness, fatigue, paresthesia

Misc: HYPERSENSITIVITY REACTIONS (including angioedema), SEROTONIN SYNDROME

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

• Use with other  CNS depressants, including  benzodiazepines,  sedative/hypnotics,  anxiolytics,  opioids, or  alcohol, may cause profound sedation; avoid concurrent use.
• ↑ risk of serotonin syndrome with  SSRIs,  SNRIs,  TCAs,  MAO inhibitors,  dextromethorphan,  triptans,  trazodone,  meperidine,  bupropion, or  buspirone.
• Concurrent use with  beta blockers,  diltiazem,  verapamil,  digoxin,  clonidine, or  ivabradine  may result in further ↓ in heart rate; use concomitantly with caution.
• May ↑ levels and risk of toxicity of  P-glycoprotein substrates  .

Drug-Natural Products:

↑ risk of serotonin syndrome with  St. John's wort or  SAMe .

Route/Dosage

PO (Adults): 50 mg, 100 mg, or 200 mg as a single dose (not to exceed one dose/24 hr).

Availability

Tablets: 50 mg, 100 mg

Assessment

• Assess pain location, intensity, duration, and associated symptoms (photophobia, phonophobia, nausea, vomiting) during migraine attack.
• Assess for occurrence of signs and symptoms of serotonin syndrome periodically during therapy.

Implementation

• PO Administer without regard to food. Do not administer >1 dose/24 hr; a 2nd dose for same migraine is not effective.

Patient/Family Teaching

• Instruct patient to take lasmiditan as directed and not take more than 1 dose in 24 hr. Advise patient to read  Patient Information  before starting therapy and with each Rx refill in case of changes.
• Inform patient that lasmiditan should be used only  during  a migraine attack. It is meant to be used for relief of migraine attacks but not to prevent or reduce the number of attacks.
• Advise patient that lying down in a darkened room after lasmiditan administration may further help relieve headache.
• May cause dizziness and drowsiness. Caution patient to avoid driving or other activities requiring alertness for at least 8 hr after dose. Do not take lasmiditan if unable to follow this advice.
• Advise patient to notify health care professional if signs and symptoms of serotonin syndrome (mental status changes [agitation, hallucinations, coma], autonomic instability [tachycardia, labile blood pressure, hyperthermia], neuromuscular signs [hyperreflexia, incoordination], gastrointestinal [nausea, vomiting, diarrhea] occur. Discontinue lasmiditan if symptoms occur. Concurrent use of SSRIs, SNRIs, TCAs, MAO inhibitors, trazodone, triptans, cough syrups (dextromethorphan) or herbal products (St. John's wort, SAMe) increase serotonin and may cause serotonin syndrome.
• Advise patient that overuse of acute migraine drugs (use more than 10 days/mo) may lead to exacerbation of headache (migraine-like daily headaches, or as a marked increase in frequency of migraine attacks). May require gradual withdrawal of lasmiditan and treatment of symptoms (transient worsening of headache).
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially St. John's wort.
• Advise patient to avoid taking other CNS depressants and alcohol, which aggravates headaches and may cause profound sedation, during lasmiditan use.
• Advise patient that lasmiditan is a drug with known abuse potential. Protect it from theft, and never give to anyone other than the individual for whom it was prescribed. Store out of sight and reach of children, and in a location not accessible by others.
• Rep:  Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Encourage pregnant patients to enroll in pregnancy exposure registry that monitors outcomes of women exposed to lasmiditan during pregnancy by contacting 1-833-464-4724 or visit www.migrainepregnancyregistry.com.

Evaluation/Desired Outcomes

Relief of migraine attack.