Reyvow Drug Interactions: What to Avoid and What to Tell Your Doctor

Why Reyvow Drug Interactions Matter

Reyvow (lasmiditan) is a serotonin 5-HT1F receptor agonist used for acute migraine treatment. Because it affects serotonin pathways and certain drug transport systems in your body, it can interact with several common medications. Knowing these interactions can help you avoid serious — and sometimes life-threatening — complications.

Important: Reyvow is being permanently discontinued by Eli Lilly, with U.S. distribution ending May 31, 2026. If you're transitioning to a different medication, understanding Reyvow's interaction profile can help your doctor choose a safer alternative. For more on the discontinuation, see our Reyvow discontinuation update.

Major Drug Interactions

1. Serotonergic Medications — Risk of Serotonin Syndrome

This is the most important interaction to know about. Taking Reyvow with other medications that increase serotonin levels can cause serotonin syndrome — a potentially life-threatening condition.

Medications that increase serotonin syndrome risk when combined with Reyvow:

• SSRIs (selective serotonin reuptake inhibitors) — Fluoxetine (Prozac), Sertraline (Zoloft), Escitalopram (Lexapro), Paroxetine (Paxil), Citalopram (Celexa)
• SNRIs (serotonin-norepinephrine reuptake inhibitors) — Venlafaxine (Effexor), Duloxetine (Cymbalta), Desvenlafaxine (Pristiq)
• Tricyclic antidepressants (TCAs) — Amitriptyline, Nortriptyline, Imipramine
• MAOIs (monoamine oxidase inhibitors) — Phenelzine (Nardil), Tranylcypromine (Parnate), Selegiline
• Trazodone — Commonly prescribed for sleep
• Other triptans — Sumatriptan, Rizatriptan, Zolmitriptan (if switching medications)

Symptoms of serotonin syndrome include:

• Agitation and restlessness
• Rapid heartbeat
• High body temperature
• Muscle twitching, rigidity, or tremors
• Loss of coordination
• Hallucinations
• Nausea, vomiting, diarrhea

What to do: If you take any of these medications, tell your doctor before starting Reyvow. Your doctor will weigh the risks and benefits. If you're prescribed both, watch closely for serotonin syndrome symptoms — especially during the first few hours after taking Reyvow. Seek emergency care immediately if symptoms develop.

Many migraine patients also take antidepressants, so this interaction is extremely relevant. Don't stop your antidepressant without medical guidance — your doctor needs to manage both conditions.

2. P-glycoprotein (P-gp) Substrates

Reyvow inhibits P-glycoprotein, a protein that acts as a pump to move certain drugs out of cells. When Reyvow blocks this pump, levels of P-gp substrate drugs can increase in your body — potentially to unsafe levels.

P-gp substrate medications affected by Reyvow:

• Dabigatran (Pradaxa) — A blood thinner. Increased levels raise bleeding risk.
• Digoxin (Lanoxin) — A heart medication. Increased levels can cause dangerous heart rhythm problems.

What to do: If you take dabigatran or digoxin, your doctor may need to adjust your dose or monitor your blood levels more closely when you use Reyvow. Do not stop these medications on your own.

3. BCRP Substrates

Reyvow also inhibits BCRP (breast cancer resistance protein), another drug transport protein. This can increase blood levels of medications that are BCRP substrates.

BCRP substrate medications affected by Reyvow:

• Rosuvastatin (Crestor) — A cholesterol-lowering statin. Increased levels may raise the risk of muscle-related side effects (myopathy).

What to do: Tell your doctor if you take rosuvastatin or other statins. They may want to monitor you for muscle pain, tenderness, or weakness.

4. Alcohol and CNS Depressants

Reyvow causes CNS (central nervous system) depression — drowsiness, dizziness, and impaired coordination. Combining it with alcohol or other CNS depressants makes these effects significantly worse.

CNS depressants to be cautious with:

• Alcohol
• Benzodiazepines (Xanax, Valium, Ativan, Klonopin)
• Sleep medications (Ambien, Lunesta)
• Opioid pain medications (hydrocodone, oxycodone)
• Antihistamines that cause drowsiness (diphenhydramine/Benadryl)
• Muscle relaxants (cyclobenzaprine, tizanidine)

What to do: Avoid alcohol completely when taking Reyvow. If you take any CNS depressants, tell your doctor. The combined sedation effect intensifies the driving impairment that already comes with Reyvow. Learn more about this in our Reyvow side effects guide.

5. Heart Rate-Lowering Medications

Reyvow may slow heart rate. Combining it with other medications that lower heart rate can potentially cause bradycardia (dangerously slow heart rate).

Medications that may interact:

• Beta-blockers (propranolol, metoprolol, atenolol) — which are also commonly used for migraine prevention
• Calcium channel blockers (diltiazem, verapamil)
• Digoxin

What to do: If you take a beta-blocker for migraine prevention or blood pressure, tell your doctor. They'll assess whether Reyvow is still appropriate for you.

Moderate Drug Interactions

Dextromethorphan (DXM)

Dextromethorphan is a common ingredient in over-the-counter cough medicines (Robitussin DM, DayQuil, NyQuil). It has mild serotonergic activity, and combining it with Reyvow may slightly increase serotonin syndrome risk.

What to do: Avoid cough medicines containing dextromethorphan while taking Reyvow, or use them with caution. Ask your pharmacist for non-serotonergic alternatives.

St. John's Wort

This popular herbal supplement is used for mild depression and mood support. It increases serotonin levels and can contribute to serotonin syndrome when combined with Reyvow.

What to do: Tell your doctor if you take St. John's Wort. They may advise you to stop it before using Reyvow.

Food Interactions

Reyvow can be taken with or without food. The main food-related concern is alcohol:

• Avoid alcohol entirely when taking Reyvow. Alcohol enhances CNS depression, worsening drowsiness, dizziness, and impaired coordination. Combined with the 8-hour driving restriction, alcohol use creates serious safety risks.

What to Tell Your Doctor Before Taking Reyvow

Before your doctor prescribes Reyvow, make sure they know about:

• All prescription medications you take — especially antidepressants, blood thinners, heart medications, and statins
• Over-the-counter medications — including cough medicines, sleep aids, and antihistamines
• Herbal supplements — especially St. John's Wort
• Alcohol use
• Other migraine medications — including triptans and CGRP medications

Bring a complete medication list to every appointment. This is the single most important thing you can do to prevent dangerous drug interactions.

Switching Away From Reyvow

With Reyvow being discontinued, many patients will need to switch to a different acute migraine treatment. If you've been taking Reyvow alongside other medications without issues, let your new prescriber know. Your interaction profile will be different with a new medication.

For help choosing an alternative, read our guide to Reyvow alternatives. To learn more about Reyvow's mechanism of action and why these interactions occur, see how Reyvow works.

The Bottom Line

Reyvow's most serious drug interactions involve serotonergic medications (SSRIs, SNRIs, TCAs, MAOIs), P-gp substrates (dabigatran, digoxin), and CNS depressants including alcohol. Always provide your doctor with a complete list of everything you take — prescriptions, OTC medications, and supplements. If you experience symptoms of serotonin syndrome after taking Reyvow, seek emergency medical care immediately.

If you need to fill a Reyvow prescription before supply runs out, MedFinder can help you find pharmacies with remaining stock.