STEPS

New Drug Reviews

Lasmiditan (Reyvow) for the Treatment of Acute Migraine

 

Am Fam Physician. 2020 Dec 15;102(12):756-757.

Lasmiditan (Reyvow) is a 5-HT1F receptor agonist labeled for the treatment of acute migraine with or without aura in adults.

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DrugDosageDose formCost*

Lasmiditan (Reyvow)

50 mg, 100 mg, or 200 mg taken once in a 24-hour period as needed

Tablet

$83 per tablet


*—Estimated lowest GoodRx price for one tablet. Actual cost will vary with insurance and by region. Information obtained at https://www.goodrx.com (accessed November 4, 2020; zip code: 66211).

DrugDosageDose formCost*

Lasmiditan (Reyvow)

50 mg, 100 mg, or 200 mg taken once in a 24-hour period as needed

Tablet

$83 per tablet


*—Estimated lowest GoodRx price for one tablet. Actual cost will vary with insurance and by region. Information obtained at https://www.goodrx.com (accessed November 4, 2020; zip code: 66211).

Safety

Lasmiditan may cause impairment and sleepiness due to central nervous system depression. Patients should be advised not to drive for at least eight hours after taking lasmiditan, or longer if they still feel impaired. Combining the medication with other central nervous system depressive agents requires caution.1 Less common severe adverse effects include serotonin syndrome, which occurred in two out of 4,878 patients in initial trials, and bradycardia (average reduction of 10 beats per minute), which was more pronounced in combination with propranolol (average reduction of 19 beats per minute).1,2 Some patients (about 1%) may experience hallucinations or euphoria, and there is a potential for abuse; as a result, lasmiditan is a controlled substance (schedule V).1 Lasmiditan has not been studied in pregnant or breastfeeding patients.

Tolerability

The most common adverse effects include dizziness (up to 15%), paresthesia (up to 9%), somnolence (up to 7%), and fatigue (up to 6%), which are dose-dependent and appear to decrease with subsequent use.2 Dizziness was more common in patients older than 65 years.1 Over three to 12 months of study, about 11% to 14% of patients discontinued lasmiditan because of adverse effects, with higher rates of discontinuation at higher doses.1

Effectiveness

In two

Address correspondence to Cara Marshall, MD, at cmarshall@glfhc.org. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

1. Daily Med. Drug label information: Reyvow—lasmiditan tablet. Accessed June 30, 2020. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=aea3358c-ff41-4490-9e6d-c7bf7b3de13f...

2. Center for Drug Evaluation and Research. Summary review. Application number: 211280. Accessed June 30, 2020. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/211280Orig1s000SumR.pdf

3. Loo LS, Ailani J, Schim J, et al. Efficacy and safety of lasmiditan in patients using concomitant migraine preventive medications: findings from SAMURAI and SPARTAN, two randomized phase 3 trials. J Headache Pain. 2019;20(1):84.

4. Loo LS, Plato BM, Turner IM, et al. Effect of a rescue or recurrence dose of lasmiditan on efficacy and safety in the acute treatment of migraine: findings from the phase 3 trials (SAMURAI and SPARTAN). BMC Neurol. 2019;19(1):191.

5. Lipton RB, Lombard L, Ruff DD, et al. Trajectory of migraine-related disability following long-term treatment with lasmiditan: results of the GLADIATOR study. J Headache Pain. 2020;21(1):20.

STEPS new drug reviews cover Safety, Tolerability, Effectiveness, Price, and Simplicity. Each independent review is provided by authors who have no financial association with the drug manufacturer.

This series is coordinated by Allen F. Shaughnessy, PharmD, MMedEd, assistant medical editor.

A collection of STEPS published in AFP is available at https://www.aafp.org/afp/steps.

 

 

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