SUPERStudy: Lasmiditan

By usmlevideoss

Introduction

Lasmiditan is a new-generation medication used for the acute treatment of migraine. It is distinct from traditional triptans because it does not cause vasoconstriction, making it a safer option for patients with cardiovascular disease.

Class of Drugs

🔹 Selective 5-HT1F Receptor Agonist (Ditans)
Lasmiditan is the first-in-class 5-hydroxytryptamine1F (5-HT1F) receptor agonist to win FDA approval.  Lasmiditan belongs to the “ditan” class, which targets 5-HT1F serotonin receptors to relieve migraines without vascular effects.

Similar Drugs

🔹 Other Drugs in the Class:

  • None currently FDA-approved aside from Lasmiditan
  • Triptans (e.g., Sumatriptan, Rizatriptan) are related in use but act via 5-HT1B/1D receptors and cause vasoconstriction.

Mechanism of Action

🔹 Selective 5-HT1F receptor agonist: 5-HT1F receptors are expressed on peripheral and central sensory neurons in the trigeminal ganglion and nucleus caudalis, respectively. As 5-HT1F receptor agonists, ditans hyperpolarize nerve terminals in the trigeminovascular system to inhibit neuronal firing, but do not trigger vasoconstriction.

Clinical Uses

✅ Acute treatment of migraine (with or without aura)
 ✅ Alternative to triptans for patients with cardiovascular risk factors
 🚫 Not used for migraine prevention

Adverse Effects

⚠ Common Side Effects:

  • Dizziness & sedation (CNS depression) (Major side effect) 
  • Fatigue
  • Paresthesia (tingling sensations)
  • Nausea

⚠ Serious Risks:

  • Driving impairment: Lasmiditan is associated with CNS depression, requiring caution with driving or operating heavy machinery for at least 8 hours post-dose.

Contraindications

🚫 Do NOT use in:

  • Patients requiring immediate high-alert activities (e.g., driving, operating machinery) due to sedation effects
  • Severe hepatic impairment (due to metabolism concerns)
  • Concomitant CNS depressants (e.g., alcohol, sedatives)

Memory Aid 

Lasmiditan Lulls migraine pain but makes you Lethargic!

  • L = Lasmiditan
  • L = Lethargy (sedation, dizziness, CNS depression)
  • L = Lacks vasoconstriction (safe in cardiovascular patients)

“Sorry, I just took Lasmiditan. Can you drive for me, Sweetheart?” 

SUPERPoint: Lasmiditan is a selective 5-HT1F receptor agonist used for acute migraine treatment. Unlike triptans, it does not cause vasoconstriction, making it safer for cardiovascular patients but causes sedation, requiring caution with driving.

SUPERFormula

Selective 5-HT1F agonist + No vasoconstriction + Migraine relief + Sedation & dizziness + Avoid driving = Lasmiditan 

📌 Lasmiditan offers an effective, non-vasoconstrictive option for migraine sufferers, but its sedative effects require caution in daily activities! 🚀

References: 

Goadsby PJ. Migraine and Other Primary Headache Disorders. In: Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson J. eds. Harrison’s Principles of Internal Medicine, 21e. McGraw-Hill Education; 2022.