What is the role of Zavzpret (lasmiditan) and Reyvow (lasmiditan) in treating migraines?

Role of Zavzpret and Reyvow in Treating Migraines

Zavzpret (zavegepant) and Reyvow (lasmiditan) are effective acute migraine treatments, with Reyvow being particularly valuable for patients with cardiovascular contraindications to triptans due to its non-vasoconstrictive mechanism of action.

Mechanism of Action and Classification

• Reyvow (lasmiditan):

  • First-in-class "ditan" medication that selectively targets 5-HT1F receptors 1, 2
  • Works through a neural mechanism without causing vasoconstriction 2, 3
  • Reduces production of CGRP and glutamate, important neurotransmitters in migraine pathophysiology 1

• Zavzpret (zavegepant):

  • Note: The evidence provided does not contain specific information about Zavzpret

Clinical Efficacy

• Reyvow (lasmiditan):
  • Demonstrated efficacy in multiple Phase II and Phase III clinical trials 3
  • Dose-dependent response with significant headache relief at 2 hours compared to placebo 4
  • Effective as monotherapy for acute migraine treatment 5
  • Can be used as an abortive therapy for adults taking chronic migraine preventive medication 5

Place in Therapy

• Reyvow (lasmiditan):
  • Indicated for acute treatment of migraine with or without aura 1, 5
  • Particularly valuable for patients who:
    • Have had inadequate response to triptans or other acute treatments 5
    • Have cardiovascular contraindications that prevent triptan use 2, 3
  • Represents a newer alternative to traditional migraine treatments like ergotamine derivatives and triptans 6

Safety and Adverse Effects

• Reyvow (lasmiditan):
  • Most common adverse events are CNS-related: dizziness, fatigue, vertigo, paresthesia, and somnolence 3, 4
  • Adverse events are typically mild to moderate in intensity and self-limiting 3
  • Dose-dependent increase in adverse events (65% at 50mg to 84% at 400mg vs 22% for placebo) 4
  • FDA recommends patients not drive or operate machinery for at least 8 hours after taking lasmiditan 3
  • Does not cause vasoconstriction, unlike triptans and ergotamine derivatives 2, 3

Important Clinical Considerations

• When selecting between traditional migraine treatments (triptans, ergotamine derivatives) and newer options like Reyvow:

  • Consider cardiovascular risk factors - Reyvow is safer in patients with cardiovascular disease 2
  • Weigh cardiovascular benefits against increased CNS-related side effects 2
  • Consider the timing of administration - patients should not drive for 8 hours after taking Reyvow 3

• For patients with moderate to severe migraines or those with migraines unresponsive to NSAIDs:

  • Triptans have traditionally been the standard treatment 6
  • Reyvow now offers an alternative, especially for those with cardiovascular contraindications 2

Common Pitfalls and Caveats

• Driving restrictions: Patients must be clearly informed about the 8-hour driving restriction after taking Reyvow due to CNS effects 3
• CNS side effects: Patients should be warned about potential dizziness, fatigue, and somnolence with Reyvow 4
• Medication overuse: As with other acute migraine treatments, overuse of Reyvow could potentially lead to medication overuse headaches 1
• Treatment trial period: Patients should try a medication for 2-3 headache episodes before abandoning that line of therapy 6
• Incomplete evidence: The provided evidence lacks specific information about Zavzpret, limiting the ability to make direct comparisons between these two medications