ditans

Ditans are a class of prescription medicines used for the acute treatment of migraine in adults. They are selective agonists of the serotonin 5-HT1F receptor (hence the name ditan). In contrast to triptans, which stimulate 5-HT1B/1D receptors and can cause vasoconstriction, ditans are designed to relieve migraine symptoms with minimal or no direct vascular constriction, offering a potential option for patients with cardiovascular risk factors.

Mechanism and action: Activation of 5-HT1F receptors on trigeminal pathways inhibits the release of pro-nociceptive neuropeptides and reduces signaling in the trigeminovascular system, thereby diminishing pain and associated symptoms. Because they do not predominantly cause vasoconstriction, they may have a different safety profile in some patients.

The best-known ditan is lasmiditan, marketed as Reyvow, which received approval from the U.S. Food and Drug Administration in 2019 for the acute treatment of migraine in adults. It is taken as an oral tablet in several dose strengths. Onset of relief is typically within an hour, and common adverse effects include dizziness, somnolence, and fatigue. Because of central nervous system effects, patients are advised not to drive or operate heavy machinery for at least 8 hours after dosing.

Status and outlook: Lasmiditan is the most widely studied and, to date, the only approved ditan. Other 5-HT1F agonists have been evaluated in clinical trials, but no additional ditans had been approved as of the last update. Ongoing research seeks to expand efficacy and understand safety in broader populations.