Indications

Midita is indicated for the acute treatment of migraine with or without aura in adults. It is not intended for the preventative treatment of migraine.

Pharmacology

Midita (lasmiditan) is a potent and selective agonist of the 5−HT1F​ receptor. While the exact mechanism is not fully understood, it is believed to work by inhibiting the firing of trigeminal nerves, which are thought to be the main cause of migraine pain. The 5−HT1F​ receptors are found in both the central and peripheral nervous systems and their activation leads to the hyperpolarization of nerve terminals and a reduction in neuronal activity. Lasmiditan has virtually no affinity for other 5−HT receptor subtypes or other monoamine receptors.

Dosage & Administration

The recommended oral dose is 50 mg, 100 mg, or 200 mg, to be taken as needed. Only one dose should be taken in 24 hours. Patients should not drive or operate machinery for at least 8 hours after taking the medication. A second dose has not been shown to be effective for the same migraine attack. The safety of treating more than 4 attacks in a 30-day period has not been established. Midita can be taken with or without food.

• Pediatric Use: Safety and effectiveness have not been established in pediatric patients.
• Hepatic Impairment: No dosage adjustment is needed for mild or moderate impairment. Use is not recommended for patients with severe hepatic impairment (Child-Pugh C).

Interaction

• CNS Depressants: Use with caution with alcohol or other CNS depressants, as Midita can cause sedation and other neuropsychiatric effects.
• Serotonergic Drugs: Use with caution with drugs (e.g., SSRIs, SNRIs, TCAs), over-the-counter medications (e.g., dextromethorphan), or herbal supplements (e.g., St. John's Wort) that increase serotonin, as this may increase the risk of serotonin syndrome.
• Heart Rate Lowering Drugs: Midita can lower the heart rate. Caution is advised when used with other medications that also lower heart rate (e.g., propranolol).
• P-gp and BCRP: Midita inhibits P-gp and BCRP in vitro. Concomitant use with drugs that are substrates for these transporters should be avoided.

Side Effects

The most common side effects include dizziness, fatigue, paresthesia (tingling or numbness), and sedation.

Pregnancy & Lactation

There is a lack of adequate data on the use of lasmiditan in pregnant women. Animal studies have shown adverse effects on development, including fetal abnormalities and decreased body weight, at various exposure levels. There are no data on the presence of lasmiditan in human milk, but animal studies have shown it is excreted into milk.

Precautions & Warnings

• Driving Impairment: Patients should be advised not to drive or operate machinery for at least 8 hours after each dose due to the potential for impairment.
• CNS Depression: Midita can cause CNS depression and should be used cautiously with other CNS depressants.
• Serotonin Syndrome: Reactions consistent with serotonin syndrome have been reported. The medication should be discontinued if these symptoms occur.
• Medication Overuse Headache: Detoxification may be necessary if headaches become more frequent.

Therapeutic Class

Midita is classified as a drug for migraine.

Storage Conditions

Store below 30°C, away from light and moisture. Keep out of the reach of children.