Lasmiditan (Reyvow) is an agent that can be utilized for acute migraine treatment. It works slightly differently than triptans. While triptans target serotonin receptor subtypes 1B and 1D, lasmiditan targets serotonin receptor subtype 1F. The biggest reason that this matters is that by having selective agonist activity at 1F, we can likely avoid some of the vasoactivity of the 1B and 1D receptors. Because of this lasmiditan’s biggest advantage is that it is not contraindicated in cardiovascular disease like triptans.
When comparing lasmiditan versus triptans, one must not overlook the cost. Many insurances will require special authorization or that you try triptans or other agents prior to using lasmiditan. I don’t foresee the cost issue going away anytime soon and this will often limit its use.
Rosuvastatin and sulfasalazine are two common medications that may have concentrations increase when lasmiditan is used. Most triptans won’t have this specific interaction. The theoretical serotonin drug interaction applies to both triptans and lasmiditan. Here’s a case scenario with triptan interaction you should think about.
Dosage forms are always an important consideration in migraine treatment. Ideally, you’d like to have multiple different ways to administer a migraine agent because a significant chunk of migraine patients will have nausea. Triptans provide way more administration options versus lasmiditan. Lasmiditan is only available as an oral agent.
By law, lasmiditan is a controlled substance so there are some restrictions associated with it compared to triptans which are not classified as a controlled substance.
Lasmiditan is an oral tablet that is only recommended to give once per day which differs from commonly used triptans where the dose can be repeated. If the patient desires to have the option of taking a second dose, then this is a potential disadvantage of lasmiditan.
In summing up our comparison of these two migraine treatments, the biggest potential advantage of lasmiditan is its ability to be used in patients at higher cardiovascular risk. The triptans hold the advantage when it comes to cost and availability of dosage forms.
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