Ditans for Migraine

Ditans are a new option for acute treatment of moderate-to-severe migraine. Reyvow™ (lasmiditan) is the first drug in this class. It was approved in October 2019.¹ Reyvow may be offered to people who cannot take triptans or do not respond to triptans.

How are ditans different from triptans?

One important difference is that triptans constrict blood vessels, and ditans do not.² Ditans may be an option for people with diseases that affect the heart or blood vessels.² Triptans may not be safe for this group of people.

This difference is based on how the drugs work. Triptans and ditans relieve migraine by affecting the serotonin receptors. But there are many subtypes of serotonin receptors. Triptans bind to the 5-HT1B and 5-HT1D receptor subtypes. Binding to these receptors constricts blood vessels throughout the body, which might not be safe for people with heart disease.

How does Reyvow work?

Reyvow, a ditan, binds to the 5-HT1F receptor subtype.³ The 5-HT1F receptors are found mainly within the brain. This receptor prevents the trigeminal nerve from releasing CGRP (calcitonin gene-related peptide).⁴ CGRP is a neuropeptide, a small protein that transmits signals in the brain. It has an important role in migraine pain. By binding to 5-HT1F, Reyvow prevents the release of CGRP and reduces the pain processes in the brain. It may work in other ways as well. Its mechanism is not entirely known.⁵ The muscle around blood vessels does not have 5-HT1F receptors. Therefore, Reyvow does not cause the blood vessels to narrow.

How well does Reyvow work?

Hundreds of people were treated with Reyvow in large, high-quality studies.^6,7 Depending on the dose of Reyvow, the trials showed that approximately:^6,7

• 33 percent are pain-free at 2 hours.
• 60 percent have pain relief at 2 hours.
• 40 percent are free of their most bothersome migraine symptom at 2 hours.
• 20 percent have sustained pain relief 24 hours after treatment.

These results are based on groups of study participants. These results do not tell you whether a medication will work for you personally.

Can people with heart disease take Reyvow?

About 80 percent of the people treated with Reyvow in clinical trials had a risk factor for heart disease.⁶ About 40 percent had 2 or more cardiovascular risk factors. These risk factors included: age over 40, high total cholesterol, low good cholesterol, high blood pressure, history of diabetes, and current smoking. Very few people experienced side effects related to the heart. Out of 1,239 people in the study, 6 (<1 percent) had heart palpitations.⁶ Three people reported changes in heart rate. However, Reyvow may lower heart rate in people taking heart rate lowering drugs.⁵

This is promising news for people with migraine and heart disease. Information from your health care provider and the results of these studies can help you make an informed choice about taking Reyvow.

What are possible side effects?

Reyvow causes dizziness, sleepiness, and tiredness. The medication label warns people not to drive or operate machinery for at least 8 hours after taking a dose of Reyvow.⁵ You should not drink alcohol or take other medications that make you drowsy while taking Reyvow. Other common side effects are numbness and tingling.

The safety of treating an average of more than 4 migraine attacks in a 30-day period has not been established.

People who take Reyvow with certain anti-depressant medications are at risk of serotonin syndrome. These medications include SSRIs (selective serotonin reuptake inhibitors) or SNRIs (serotonin-norepinephrine reuptake inhibitors). Symptoms of serotonin syndrome are mental changes, fast heart rate, high body temperature, muscle tightness, or difficulty walking.

These are not all the possible side effects of Reyvow. Patients should talk to their doctor about what to expect with treatment with Reyvow.