Use in Adults
Ditans

​THIS GUIDE PROVIDES A PARTIAL LISTING OF PRESCRIBING INFORMATION FOR THIS MEDICATION. FOR A FULL LISTING OF PRESCRIBING INFORMATION PLEASE REFER TO THE PACKAGE INSERT. CLICK ON THE BRAND NAME® TO VIEW THE LINK TO THE PACKAGE INSERT.

Lasmiditan (Reyvow®) Click Here to Expand)

Brands:

• Reyvow® (lasmiditan) For more complete prescribing information click here for PACKAGE INSERT

Dosages Available:

• 50 and 100 mg tablets

Initial Dose: 

• 100 mg is the preferred starting dose
• May use 50 mg dose if 100 mg dose is not tolerated
• May use two 100 mg tablets (total dose of 200mg) as starting dose if not pain free or adequate pain relief with lower dosages ​

Dose Schedule:  

• Take one dose (50 mg, 100 mg or 200 mg) at onset of migraine attack as needed for the treatment of an acute migraine attack 
• No evidence for benefit from second dose

​Max Daily Dose:

• 200 mg

Side Effects:

• Dizziness (severe 1% and mild to moderate in 15-20%)
• Sedation, fatigue, paresthesia

Headache Specialist Comments: 

• Consider use in the following patients:
  • Primary therapy in those with known cardiovascular disease or other contraindications to use of the triptans
  • Used as rescue therapy for those not attaining an adequate response after 2 hours to the initial dosage of an acute medication
• There is no evidence from clinical studies that ditans are more efficacious than triptans, gepants or ergots.
• The main advantages of lasmiditan are early pain free efficacy, despite treating later in a migraine attack (from clinical trial data) and its lack of a cardiovascular contraindication to its use. 

The main disadvantages include the need to avoid driving for 8 hours after use, and its side effects of dizziness, which is severe in 1% and mild to moderate in 15-20%, and the requirement of many insurance carriers for prior authorization
Precautions and Risk:  

• Lasmiditan should not be taken unless the patient can wait at least 8 hours between dosing and driving or operating machinery. 
• Lasmiditan is a Schedule V controlled substance (C-V). Avoid in patients with history of substance abuse.

Contraindications:  

• None

Pregnancy:

• Click Reyvow® and navigate to #8 Use in Specific Populations (8.1 & 8.2)

Common Drug Interactions:

• Use with caution with any other CNS depressants known to cause sedation, to avoid combination effect
• Be vigilant for development of serotonin syndrome in those receiving other serotonergic medications
• May decrease heart rate when administered with a negative chronotropic drug
• It is unknown if lasmiditan is associated with serotonin syndrome when used along with other serotonergic medications.

​Counseling Tips:  

• Might be best administered when at home when no need to drive for 8 hours;