Section 02 · Monograph
Lasmiditan
Reviewed Nov 2026FDA label
ReyvowDitan
- Forms
- Tab: 50, 100, 200mg
- Dose
- 50-200mg PRN (avoid driving 8h)
- MOA
- Selective 5-HT1F agonist (non-vasoconstrictive)
Indications
- Acute treatment of migraine with or without aura in adultsFDA-labeled
- Not indicated for migraine preventionFDA-labeled
Mechanism of Action
- Selective agonist at the 5-HT1F receptor; unlike triptans and ergots, has minimal to no vasoconstrictive activity at clinically relevant concentrations — the therapeutic effect is presumed to occur via 5-HT1F–mediated inhibition of trigeminal pain pathways rather than vasoconstriction, allowing use in patients with cardiovascular disease/risk factors in whom vasoconstrictors are contraindicated
Full Dosing
Adult / usual
- 50 mg, 100 mg, or 200 mg orally, taken as a single dose as needed, without regard to food
- Maximum one dose per 24-hour period
- Effectiveness of treating more than one dose per attack not established
- Tablets should be swallowed whole
Contraindications
- No specific contraindications are listed in labeling
Drug Interactions
- Additive CNS depression with alcohol, opioids, benzodiazepines, and other CNS depressants
- Serotonergic drugs (SSRIs, SNRIs, TCAs, MAOIs, triptans) — increased theoretical risk of serotonin syndrome
- Heart-rate-lowering agents (e.g., beta-blockers): can produce additional modest heart rate reduction
- P-glycoprotein substrates (e.g., digoxin): co-administration not recommended due to potential increased substrate exposure
Adverse Effects
- Common (≥5%): dizziness, fatigue, paresthesia, sedation/somnolence
- Also reported: vertigo, muscular weakness, visual impairment, palpitations, and (uncommonly) hallucinations
- CNS depression is dose-dependent and can impair the ability to safely drive or operate machinery
Monitoring Parameters
- Driving/machinery impairment warning: instruct patients not to drive or operate machinery for at least 8 hours after each dose, even if they feel well enough to do so
- Schedule V controlled substance — assess for misuse/abuse potential and monitor accordingly
- Monitor heart rate/blood pressure with concomitant heart-rate-lowering drugs or in patients at cardiovascular risk
- Reassess need for continued use if not effective
Pregnancy & Lactation
- No adequate human pregnancy data; animal studies showed fetal structural abnormalities and reduced fetal weight at clinically relevant exposures — enrollment in the Reyvow pregnancy registry (1-833-464-4724) is encouraged
- No human lactation data; excreted into milk in animal studies at levels roughly 3-fold maternal plasma — weigh benefits of breastfeeding against potential infant exposure, particularly CNS depression