II. Indications

  1. Acute Migraine Headache
    1. Third-line agent in acute Migraine Headache regardless of aura refractory to NSAIDS and Triptans
    2. Consider in patients for whom Triptans are contraindicated (e.g. Cardiovascular Risk Factors)

III. Mechanism

  1. Selective Serotonin5-HT1F Receptor Agonist
    1. Differs from Triptan binding sites (no Vasoconstrictor activity)

IV. Preparations

  1. Reyvow (Lasmiditan)
    1. Costs $85 per tablet (contrast with 70 cents per Sumatriptan tablet)
    2. Limit to 4 doses per month

V. Dosing

  1. Single dose, and no benefit from re-dosing <24 hours
  2. Available as 50, 100 and 200 mg doses
  3. Do not drive a vehicle, operate machinery or other dangerous activities within 8 hours of dose

VI. Efficacy

  1. NNT 10 for one patient to be pain free at 2 hours
    1. Contrast with NNT 5 for Sumatriptan
    2. Although 50% are pain at 2 hours, 43% are pain free at 2 hours after Placebo

VII. Adverse Effects

  1. Does NOT cause vasospasm (in contrast to Triptans)
  2. Transient minor increases in Blood Pressure (2-3 mmHg) and decreased Heart Rate (5-10 bpm) after 200 mg dose
  3. Euphoria and Hallucinations
    1. Do not drive for 8 hours after dose
    2. Schedule V agent
  4. Serotonin Syndrome
  5. Other more common side effects
    1. Dizziness (17%, dose dependent)
    2. Fatigue
    3. Paresthesias
    4. Sedation
    5. Nausea and Vomiting
    6. Muscle Weakness

VIII. References

  1. (2020) Presc Lett 27(3): 13
  2. Bowman (2020) Crit Dec Emerg Med 34(11): 28
  3. LoVecchio (2019) Crit Dec Emerg Med 33(12): 31

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