Reyvow vs. Imitrex for Migraines: 8 Differences You Should Know About
Key takeaways:
Reyvow (lasmiditan) and Imitrex (sumatriptan) are two FDA-approved medications that treat migraines. When considering Reyvow versus Imitrex for migraine treatment, Imitrex is usually tried first. Then, Reyvow is an option if you can’t take Imitrex.
Reyvow is only available as a brand-name medication, but Imitrex is available as both a generic and a brand-name medication. Both medications come as oral tablets. Imitrex is also available as a nasal spray, nasal powder, and injection.
Reyvow and Imitrex work differently to treat migraines. So if Imitrex doesn’t relieve your migraine symptoms, Reyvow may be able to help. The two medications can even be used together in some cases.
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Table of contents
Living with migraines can be a daily challenge. But treatment is available. Medications, such as Reyvow (lasmiditan) and Imitrex (sumatriptan), can treat migraine headaches once they begin. Others can help prevent them entirely.
Below, we’ll take an in-depth look at Reyvow versus Imitrex and discuss eight key differences that may help determine which migraine medication is better for you.
1. They work differently to treat migraines
Both Reyvow and Imitrex are approved to treat migraine headaches. But they work in different ways.
Reyvow’s mechanism of action
Experts aren’t completely sure how Reyvow works. But we know that Reyvow is classified as a serotonin (5-HT) 1F receptor agonist, which means it activates certain serotonin receptors (chemical binding sites) in the brain. This boosts the effects of serotonin, a chemical messenger involved in many processes in the body and brain.
It’s been suggested that low serotonin levels can widen (dilate) your blood vessels and cause migraines. However, recent evidence indicates that low serotonin levels don’t actually contribute to migraines. So experts don’t think that Reyvow’s effect on serotonin is how it treats migraines.
How Reyvow works is more likely due to its effects on two key substances: calcitonin gene-related peptide (CGRP) and glutamate. Both of these substances typically surge during a migraine episode. When Reyvow binds to serotonin receptors, it prevents the release of these substances. This can alleviate migraine symptoms like pain, nausea, and photophobia (sensitivity to light).
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Imitrex’s mechanism of action
Imitrex is part of a group of medications called triptans. Like Reyvow, Imitrex binds to serotonin receptors throughout the body. But Imitrex binds to (5-HT) 1B and (5-HT) 1D receptors.
Previously, Imitrex was thought to work by tightening (constricting) blood vessels to relieve migraines. But now, experts think Imitrex works by binding to serotonin receptors and blocking the release of migraine-related peptides, like CGRP. This disrupts pain signals before they reach the brain, reducing the sensation of pain.
2. Imitrex is considered a first-choice medication for migraines, but Reyvow usually isn’t
Imitrex is a first-choice medication for moderate-to-severe migraines. However, triptans, including Imitrex, don’t work for up to 30% of people who take them. In these cases, other migraine medications, like Reyvow, may be better options.
Additionally, if you’re someone who can’t take Imitrex, Reyvow may be tried first. For example, you may need to avoid Imitrex if you have a history of stroke or unmanaged hypertension (high blood pressure).
It’s also possible that your healthcare professional could prescribe you Imitrex and Reyvow together. Some research shows that, if migraine symptoms don’t improve after taking Imitrex, taking a dose of Reyvow can help.
Is Reyvow or Imitrex more effective?
Large reviews that studied tens of thousands of people have compared Imitrex to other migraine medications, including Reyvow. These studies showed that, while Imitrex and Reyvow both reduced migraine pain, Imitrex was more effective than Reyvow.
3. They have different recommended dosages
Reyvow and Imitrex come as oral tablets that you take as soon as you feel a migraine attack . With Imitrex, if your migraine symptoms don’t improve after your first dose, you can take a second dose as soon as 2 hours later. However, you shouldn’t take more than 1 dose of Reyvow in a 24-hour period.
Reyvow comes as 50 mg, 100 mg, and 200 mg tablets. Your prescriber can help you decide which dose is best for you.
Imitrex comes in 25 mg, 50 mg, and 100 mg tablets. Typically, 100 mg is the maximum amount that’s taken in a single dose. And 200 mg is the maximum daily dose.
4. Imitrex comes in different forms
Reyvow is only available as a tablet; it doesn’t come in any other forms. But Imitrex is available in other dosage forms, including a:
Nasal spray (Imitrex, Tosymra)
Subcutaneous (under the skin) injection (Imitrex STATDose, Zembrace SymTouch)
Nasal powder (Onzetra Xsail)
5. Reyvow is only a brand-name medication, but Imitrex also comes as a generic
There isn’t a generic Reyvow available; it only comes as a brand-name medication. On the other hand, all forms of Imitrex, except for the nasal powder, are available as generic medications.
Because Reyvow is only available as a brand-name medication, it’s generally more expensive than generic Imitrex products.
6. Reyvow is a controlled substance, so there are restrictions around how it’s prescribed
Reyvow is a controlled substance because it has the potential to cause dependence and misuse. So there are restrictions on how it’s prescribed and refilled. Taking Reyvow exactly as prescribed limits your risk of dependence and misuse. This means taking no more than 1 dose per 24-hour period and 4 doses per 30-day period.
Imitrex isn’t a controlled substance, so it doesn’t have these same risks or restrictions.
7. Reyvow and Imitrex have different side effects
Reyvow and Imitrex have some shared side effects. But they also have some unique ones.
Shared side effects
Both Reyvow and Imitrex can cause:
Dizziness
Fatigue
Tiredness
Pins and needles sensation (paresthesias)
More seriously, they can both cause serotonin syndrome when combined with other medications that increase serotonin. Symptoms of serotonin syndrome include a fast heartbeat, tremors, and heavy sweating. In rare cases, seizures or loss of consciousness can occur.
Additionally, if you take Reyvow or Imitrex more often than recommended, you may develop rebound headaches. So keep in mind that Reyvow and Imitex aren’t typically meant to be taken more than 4 times per month. If you need migraine medication more often, this may be a sign you need a preventive migraine treatment, as well. Ask your prescriber about whether this is a good option for you.
Unique side effects
Reyvow has some unique side effects — such as muscle weakness, nausea, and vomiting — in addition to the above shared side effects. Reyvow can also cause severe drowsiness and dizziness. That’s why it’s necessary to wait at least 8 hours after taking a dose of Reyvow before doing activities that require alertness, like driving.
As mentioned, Reyvow can also cause dependence and misuse. And while very rare, there’s a small chance of heart-related side effects, such as high blood pressure, with Reyvow.
Imitrex also has some unique, rare side effects. This includes body temperature issues (feeling too hot or cold) and temporary pressure or pain in the chest, neck, or jaw. More seriously, Imitrex can cause heart problems like high blood pressure, heart attack or stroke, and an irregular heartbeat (arrhythmia).
8. They have different drug interactions
Reyvow and Imitrex both have potential drug interactions. Many of these interactions increase your risk of unwanted side effects.
Since Reyvow can cause drowsiness and dizziness, it interacts with medications and substances that also have these side effects. This includes alcohol, benzodiazepines, and opioids. And because Reyvow can decrease your heart rate, it interacts with medications that have the same effect. Examples include heart medications like propranolol (Inderal LA), verapamil (Verelan), and digoxin (Lanoxin).
One unique Imitrex interaction is with ergot derivatives, such as ergotamine (Ergomar) and bromocriptine (Parlodel). These are older medications that aren’t commonly used anymore. Still, they shouldn’t be taken within 24 hours of Imitrex to avoid the risk of dangerously high blood pressure.
Reyvow and Imitrex both interact with medications that increase serotonin levels, including:
Selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft) and citalopram (Celexa)
Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor XR) and duloxetine (Cymbalta)
Monoamine oxidase inhibitors (MAOIs), such as selegiline and linezolid (Zyvox)
Certain over-the-counter (OTC) medications and supplements, such as St. John’s wort and dextromethorphan (Robitussin)
As mentioned, the risk of combining Reyvow or Imitrex with these medications (or each other) is serotonin syndrome. This rare condition is caused by having too much serotonin in the blood. Although rare, it’s more likely to occur if you take multiple medications that increase serotonin.
Choosing between Reyvow and Imitrex
For most people, Imitrex is a first-choice medication for the treatment of migraines. This is because it’s known to be effective and well tolerated. And it’s typically inexpensive since all of the forms (except the nasal powder) are available as generics. However, if you have an existing heart condition, your prescriber may suggest starting with Reyvow.
As mentioned, even though Imitrex is a first-choice migraine treatment, it isn’t effective for everyone. Your prescriber may suggest trying a different triptan if Imitrex isn’t working for you. Or they may recommend another type of migraine medication, such as Reyvow. If you get frequent migraines, they may also suggest taking a preventative migraine medication.
How to save on Reyvow and Imitrex
There are ways to save on Reyvow and Imitrex. Both are available as brand-name medications. But Imitrex is also available as a generic tablet, nasal spray, and injection.
Savings options for Reyvox and Imitrex include:
Save with GoodRx. At certain pharmacies, a prescription for 9 generic Imitrex tablets may cost as low as $11.00 with a free GoodRx coupon. Other generic Imitrex products, like sumatriptan nasal spray and the injection, may also cost less with a GoodRx coupon.
Save with a copay savings card. If you have commercial insurance, you may be able to get Reyvow at no cost with a savings card from the manufacturer. You may also qualify for manufacturer savings programs for brand-name sumatriptan products like Tosymra, Zembrace SymTouch, and Onzetra Xsail.
The bottom line
Reyvow (lasmiditan) and Imitrex (sumatriptan) both treat migraine symptoms once they begin. When considering Reyvow versus Imitrex for migraine relief, Imitrex is usually the first-choice option. But Reyvow may be an option if Imitrex doesn’t work or you can’t take Imitrex for certain health reasons.
Reyvow and Imitrex work in unique ways, and they have other key differences. Reyvow is only available as a brand-name medication, while Imitrex comes as a generic tablet, nasal spray, and injection. Only Reyvow is classified as a controlled substance, because it carries a risk of dependence and misuse. On the other hand, Imitrex can cause heart problems, including high blood pressure, although these side effects are rare.
If you have migraines, talk to your healthcare professional about your options. They can help you determine which migraine medication is the right one for you.
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References
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