Pharm

Ditan

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Ditan, Lasmiditan, Reyvow

  • 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)
  • Mechanism
  1. Selective Serotonin5-HT1F Receptor Agonist
    1. Differs from Triptan binding sites (no Vasoconstrictor activity)
  • Preparations
  1. Reyvow (Lasmiditan)
    1. Costs $85 per tablet (contrast with 70 cents per Sumatriptan tablet)
    2. Limit to 4 doses per month
  • 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
  • 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
  • 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
  • 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