Lacosamide

General

  • Type: Anticonvulsant
  • Dosage Forms: 50, 100, 150, 200 PO/IV; 10/mL sol IV
  • Common Trade Names: Vimpat

Adult Dosing

  • Monotherapy
    • 100mg PO/IV q12hr initially, THEN, based on response and tolerability, increase dose at weekly intervals by 50mg PO/IV BID; up to a recommended dose of 150-200mg BID
    • Alternate loading dose schedule: 200mg PO/IV as a single dose, followed ~12 hr later by starting 100mg PO/IV BID x 1 week, THEN increase dose at weekly intervals by 50mg BID; up to a recommended dose of 150-200mg BID
    • In patients already taking an antiepileptic drug (AED), maintain lacosamide at recommended maintenance dose of 150-200mg PO BID for at least 3 days before initiating withdrawal of the previous AED
  • Adjunctive therapy
    • Initial: 50mg PO/IV q12hr
    • Based on response and tolerability, increase dose at weekly intervals by 50mg PO/IV BID; up to a recommended dose of 100-200mg BID
  • Max 400mg/day

Pediatric Dosing

  • Safety not established under age 17
  • >17 yo, see adult

Special Populations

  • Pregnancy Rating: C
  • Lactation: saftey unknown
  • Renal Dosing
    • Severe (CrCl <30 mL/min): Not to exceed 300mg/day
    • Hemodialysis: Supplement with up to 50% of dose after dialysis
  • Hepatic Dosing
    • Mild to moderate: Not to exceed 300mg/day
    • Severe: Not recommended

Contraindications

  • Allergy to class/drug
  • Caution in:
    • elderly
    • renal impairment
    • hepatic impairment
    • severe cardiac disease
    • cardiac conduction defects
    • diabetic neuropathy
    • depression

Adverse Reactions

Serious

  • PR prolongation
  • AV block
  • AFib
  • AFlutter
  • Syncope
  • Suicidality
  • Drug Rash with eosinophilia and systemic sx
  • Stevens-Johnson
  • Toxic epidermal necrolysis
  • withdrawal seizures if abrupt discharge
  • neutropenia
  • agranulocytosis

Common

  • >10%
    • Dizziness (31%)
    • Headache (13%)
    • Diplopia (11%)
    • Nausea (11%)
  • 1-10%
    • Vomiting (9%)
    • Ataxia (8%)
    • Blurred vision (8%)
    • Tremor (7%)
    • Nystagmus (5%)
    • Balance disorder (4%)
    • Diarrhea (4%)
    • Injection site discomfort (2.5%)
    • Depression (2%)
    • Memory impairment (2%)
    • Pruritus (2%)
    • Increased ALT (1%)
    • Local irritation (1%)

Pharmacology

  • Half-life: 13h
  • Metabolism: liver; CYP450: 2C9, 2C19, 3A4 substrate
  • Excretion: urine 95% (40% unchanged), feces <0.5%
  • Mechanism of Action: exact mechanism unknown; enhances slow inactivation of voltage-sensitive Na channels, stabilizing neuronal membranes, inhibiting repetitive firing

See Also

Anticonvulsants

References

epocrates, medscape