11 Reyvow Interactions to Watch For
Key takeaways:
Reyvow (lasmiditan) is an oral medication that treats migraine attacks. It can cause drowsiness and dizziness, which can lead to drug interactions with other medications and substances that have the same effects. These include alcohol, opioids such as Percocet (oxycodone / acetaminophen), and benzodiazepines such as alprazolam (Xanax).
Other Reyvow interactions include antidepressants such as escitalopram (Lexapro), triptans such as sumatriptan (Imitrex), and beta blockers such as metoprolol (Lopressor).
Just because you take a medication that may interact with Reyvow doesn’t always mean you need to avoid the combination. You may just need to watch carefully for signs of an interaction. However, in other cases, avoiding the combination may be recommended. Give your healthcare team a list of all the medications you take so they can check for potential interactions.
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Table of contents
When you have a migraine, you probably want it gone immediately. This is why rapid-relief medications are a must for some people.
Reyvow (lasmiditan) is an oral tablet that’s FDA-approved to treat migraine episodes in adults. It works by blocking certain substances that are typically released in the brain during a migraine. This blocks the sensation of pain.
Below, we’ll discuss 11 important Reyvow interactions to watch for. As with any medication, share a list of prescription medications and over-the-counter (OTC) products you take with your prescriber and pharmacist before starting Reyvow. This will help them check for drug interactions.
1. Alcohol
Drinking alcohol while taking Reyvow is risky. This is because they both slow your brain activity.
A single Reyvow dose will be almost entirely out of your system about 24 hours after you take it. So your prescriber might say it’s OK for you to have a drink then. However, they might suggest avoiding drinking, since alcohol is a common migraine trigger. Additionally, you don’t know when a migraine will strike, and it’s best for there to be no alcohol in your system while taking Reyvow.
2. Opioids
Opioids are typically prescribed for pain that can’t be treated by non-opioids. Examples of opioids include Percocet (oxycodone / acetaminophen), tramadol (ConZip, Qdolo), and morphine (MS Contin).
Opioid side effects are similar to the ones caused by Reyvow. So you might feel extra drowsy and dizzy if you take an opioid and Reyvow. These exaggerated effects can lead to falls and injuries. This is especially risky for older adults, who are more susceptible to injuries from falls. Combining opioids and Reyvow can also raise the risk of slowed breathing and opioid overdose.
Like opioids, Reyvow is a controlled substance. These are medications and substances that have a risk of dependence and misuse. These risks are less likely with Reyvow than with opioids. Still, the risk of misuse and other harmful effects is higher when you take multiple controlled substances.
In some cases, taking opioids and Reyvow together may be necessary. But follow your prescriber’s instructions closely if they recommend both. Alternatively, your prescriber may recommend a different migraine medication that doesn’t interact with opioids.
Reyvow side effects: Common Reyvow side effects include dizziness and drowsiness. This can affect your ability to drive. Rarely, Reyvow may also lead to dependence and misuse.
Reyvow vs. Imitrex: These two medications both relieve migraines, but one may be better for you.
Prescription migraine treatments: Several prescription medications are available to help prevent and treat migraines.
3. Benzodiazepines
Benzodiazepines are another type of medication that is best to avoid with Reyvow. Benzodiazepines relax your brain and muscles, and they’re used to treat several health conditions. Common examples of benzodiazepines include Xanax (alprazolam) and Klonopin (clonazepam).
Similar to Reyvow, benzodiazepines are well-known for their brain-slowing effects and can cause drowsiness, dizziness, and falls. Taking benzodiazepines and Reyvow together can make these side effects more likely. Benzodiazepines are also controlled substances. So like Reyvow, they have a risk of dependence and misuse.
If you regularly take benzodiazepine medication, let your prescriber know. They may recommend another migraine medication instead of Reyvow. In other cases, they may say it's OK to take Reyvow and your benzodiazepine, especially if you only take your benzodiazepine occasionally.
Keep in mind that other medications, such as muscle relaxers and gabapentin (Neurontin), can also cause drowsiness and dizziness. These may also be best avoided with Reyvow.
4. Sleep medications
Though researchers are still trying to understand why, some clues indicate that sleep troubles may cause migraines. If you have trouble sleeping, you may be curious about sleep medications that can help you fall and stay asleep. However, you may need to avoid these medications with Reyvow. This combination can cause drowsiness and dizziness, which can lead to accidents and falls.
Make sure your prescriber knows about any medications you take for sleep. Prescription examples include ramelteon (Rozerem), zolpidem (Ambien), and zaleplon (Sonata). OTC options include diphenhydramine (ZzzQuil) and doxylamine (Unisom). Don’t start any sleep medications, even OTC products, without talking to a healthcare professional first.
5. Some seizure medications, such as Keppra
Many seizure medications work by slowing down the brain. This helps calm the burst of electrical activity that can cause a seizure. But this same effect may also lead to dizziness and drowsiness when combined with Reyvow.
Examples of seizure medications that may interact with Reyvow include levetiracetam (Keppra), lamotrigine (Lamictal), and topiramate (Topamax).
You might even be taking a seizure medication without knowing it. For example, topiramate may be prescribed off-label for weight loss — and even migraines. So make sure you give your prescriber and pharmacist a list of the medications you take before starting Reyvow.
6. Antidepressants, such as Lexapro
Antidepressants are a group of medications that treat more than their name implies. For example, you might take one for anxiety, pain, or hot flashes.
Antidepressants, which are widely used, can interact with several medications. Many antidepressants interact with Reyvow by causing excess sedation. This interaction is most likely with older antidepressants, such as amitriptyline. But some newer, more commonly used antidepressants can also make you extra drowsy if you take them with Reyvow, including:
Selective serotonin reuptake inhibitors (SSRIs), such as escitalopram (Lexapro) and paroxetine (Paxil)
Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta) and venlafaxine (Effexor XR)
Additionally, Reyvow and these antidepressants both increase serotonin (a brain chemical). A serious condition called serotonin syndrome can occur in people taking multiple medications that increase serotonin. Talk to your prescriber and pharmacist about whether any of your medications increase serotonin.
7. Triptans, such as sumatriptan
Triptans are first-choice migraine medications. Examples include sumatriptan (Imitrex) and zolmitriptan (Zomig). Like Reyvow, they also attach to serotonin receptors.
Reyvow hasn’t been well studied in combination with triptans. But if you’re prescribed both, follow your care team’s recommendations for using them. It’s unlikely that taking triptans and Reyvow together could cause serotonin syndrome, but it's still possible. The risk is higher if you also take other medications that increase serotonin.
What’s more, taking multiple migraine medications also raises the risk of rebound headaches. Tell your prescriber if you need to take migraine medications often. They may recommend a change in treatment, such as adding a preventive migraine medication to your treatment plan.
8. Beta blockers, such as metoprolol
Beta blockers, such as metoprolol (Lopressor) and carvedilol (Coreg), treat heart-related conditions. They’re well known for lowering heart rate. It’s possible Reyvow might add to this effect. In clinical studies, people taking Reyvow had a small decrease in their heart rate.
For most people, this interaction isn’t a concern. But if you have a low heart rate, or you take other medications that slow heart rate, let your prescriber know before starting Reyvow.
Good to know: If you have heart or blood pressure issues, Reyvow may be a better option than triptans. Reyvow doesn’t cause blood vessel tightening like triptans, since it attaches to different receptors.
9. Calcium channel blockers
Calcium channel blockers (CCBs) are another group of medications that treat heart-related conditions. Like beta blockers, some CCBs are known for decreasing your heart rate. Examples include diltiazem (Cardizem) and verapamil.
Taking a CCB with Reyvow may cause your heart rate to drop more than taking either medication alone. So talk to your prescriber if you take a CCB. They may recommend a migraine medication that doesn’t impact heart rate.
10. Digoxin
Digoxin (Lanoxin) is a heart medication known for having a “narrow therapeutic window.” This means digoxin levels in your blood need to stay within a very specific range. Otherwise, digoxin might not work (if it's too low) or could lead to toxicity (if it's too high).
Reyvow may block a specific protein that’s involved in metabolizing (breaking down) digoxin in the body. So taking Reyvow with digoxin could increase digoxin levels, leading to digoxin toxicity. If you take digoxin, your prescriber can recommend a different migraine treatment that’s safe for you to take.
11. Pradaxa
Pradaxa (dabigatran) is a medication that prevents and treats blood clots. Like digoxin, it relies on a specific protein to be metabolized in the body. Reyvow can block this protein, increasing Pradaxa levels in the body.
High Pradaxa levels can lead to an increased risk of bleeding, so let your prescriber know if you’re taking Pradaxa before starting Reyvow. They may recommend another migraine medication. Or, they may tell you to watch for symptoms including unusual and unexplained bruising, increased bleeding from the gums, or nosebleeds.
The bottom line
Reyvow (lasmiditan) is an oral migraine-relief medication that can cause drowsiness and dizziness. Many drug interactions are preventable if you avoid combining Reyvow with medications that cause similar side effects to it. Examples include benzodiazepines such as alprazolam (Xanax), opioids such as tramadol (Qdolo, ConZip), and sleep medications such as zolpidem (Ambien). Reyvow is also best avoided with alcohol.
Other Reyvow interactions include some seizure medications such as topiramate (Topamax), beta blockers such as metoprolol (Lopressor), and calcium channel blockers such as diltiazem (Cardizem). Your prescriber or pharmacist can tell you if a specific medication can cause a Reyvow interaction. So give them a list of all your medications, including over-the-counter (OTC) products, before starting Reyvow.
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References
Aleksenko, D., et al. (2023). Headache from medication overuse. StatPearls.
Berger, A. A., et al. (2020). Lasmiditan for the treatment of migraines with or without aura in adults. Psychopharmacology Bulletin.
Blumenfeld, A., et al. (2023). Serotonin syndrome in the acute treatment landscape of migraine: The lasmiditan experience. Frontiers in Neurology.
de Boer, I., et al. (2023). Place of next generation acute migraine specific treatments among triptans, non-responders and contraindications to triptans and possible combination therapies. Cephalalgia.
Eli Lilly and Company. (2022). Reyvow- lasmiditan tablet [package insert].
Goadsby, P. J., et al. (2019). Phase 3 randomized, placebo-controlled, double-blind study of lasmiditan for acute treatment of migraine. Brain: A Journal of Neurology.
Lillo Vizin, R. C. L., et al. (2024). Unraveling the directional relationship of sleep and migraine-like pain. Brain Communications.
Shapiro, R. E., et al. (2019). Lasmiditan for acute treatment of migraine in patients with cardiovascular risk factors: Post-hoc analysis of pooled results from 2 randomized, double-blind, placebo-controlled, phase 3 trials. The Journal of Headache and Pain.
Szkutnik-Fiedler, D. (2020). Pharmacokinetics, pharmacodynamics and drug–drug interactions of new anti-migraine drugs—lasmiditan, gepants, and calcitonin-gene-related peptide (CGRP) receptor monoclonal antibodies. Pharmaceutics.
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