LASMIDITAN TAB,ORAL

Clinical Criteria Summary

Concurrent therapy with a P-glycoprotein substrates sensitive to minor changes in plasma concentration (e.g., digoxin)
Concurrent therapy with ubrogepant or rimegepant
Concurrent therapy with a triptan agent once lasmiditan is initiated
Pregnancy
Patient unable to comply with not engaging in activities requiring mental alertness (e.g. driving) for at least 8 hours after taking lasmiditan

Treatment initiated by a VA/VA Community Care neurologist or locally designated headache expert
Diagnosis of migraine, with or without aura, per the International Classification of Headache Disorders (ICHD-3)
Moderate to severe migraine intensity
Contraindication, intolerance, or lack of response to trial of two different triptans

Vascular contraindications: ischemic coronary artery disease, previous stroke or transient ischemic attack, peripheral vascular disease, ischemic bowel disease, or uncontrolled hypertension
Drug interaction-related contraindications: concurrent use of a MAO inhibitor

Adults with a history of 3–8 migraine attacks and less than 15 headache days per month.
Patients with cardiovascular risk factors or disease for whom triptan use is contraindicated.
Triptan-experienced population, including patients who did not demonstrate an acceptable response to triptans.

Doses of 50 mg, 100 mg, and 200 mg demonstrated efficacy for pain freedom at 2 hours.
Administer as the first treatment for each new migraine attack within 4 hours of pain onset.
Do not repeat a dose until more than 48 hours after treatment of an attack.

Monitor closely for CNS depression, dizziness, balance disorders, somnolence, fatigue, sedation, and paresthesia (occurring >2% greater than placebo).
Monitor closely for cardiovascular effects, including potential decrease in heart rate and/or increase in blood pressure, particularly in patients who may not tolerate these changes.
Monitor closely for signs of serotonin syndrome (mental status changes, autonomic instability, neuromuscular changes, GI symptoms, seizures) when used alone or with other serotonergic agents; discontinue immediately if signs/symptoms arise.
Patients must be able to abstain from activities requiring mental alertness for at least 8 hours after administration due to driving impairment risks.

Not recommended in patients with severe hepatic impairment.
Should not be taken with alcohol or other sedating medications.
Classified as a controlled substance monitored by the DEA; associated with euphoria and hallucinations.