Lacosamide: Difference between revisions
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==General== | ==General== | ||
*Type: Anticonvulsant | *Type: [[Anticonvulsant]] | ||
*Dosage Forms: 50, 100, 150, 200 PO/IV; 10/mL sol IV | *Dosage Forms: 50, 100, 150, 200 PO/IV; 10/mL sol IV | ||
*Common Trade Names: Vimpat | *Common Trade Names: Vimpat | ||
| Line 6: | Line 6: | ||
==Adult Dosing== | ==Adult Dosing== | ||
*Monotherapy | *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: | **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- | **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 | *Adjunctive therapy | ||
**Initial: | **Initial: 50mg PO/IV q12hr | ||
**Based on response and tolerability, increase dose at weekly intervals by | **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 | *Max 400mg/day | ||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
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*Lactation: saftey unknown | *Lactation: saftey unknown | ||
*Renal Dosing | *Renal Dosing | ||
**Severe (CrCl <30 mL/min): Not to exceed | **Severe (CrCl <30 mL/min): Not to exceed 300mg/day | ||
**Hemodialysis: Supplement with up to 50% of dose after dialysis | **Hemodialysis: Supplement with up to 50% of dose after dialysis | ||
*Hepatic Dosing | *Hepatic Dosing | ||
**Mild to moderate: Not to exceed | **Mild to moderate: Not to exceed 300mg/day | ||
**Severe: Not recommended | **Severe: Not recommended | ||
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*Syncope | *Syncope | ||
*Suicidality | *Suicidality | ||
*Drug Rash | *Drug Rash with eosinophilia and systemic sx | ||
*Stevens-Johnson | *Stevens-Johnson | ||
*Toxic epidermal necrolysis | *Toxic epidermal necrolysis | ||
*withdrawal seizures if abrupt | *withdrawal seizures if abrupt discharge | ||
*neutropenia | *neutropenia | ||
*agranulocytosis | *agranulocytosis | ||
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**Nystagmus (5%) | **Nystagmus (5%) | ||
**Balance disorder (4%) | **Balance disorder (4%) | ||
**Diarrhea (4%) | **[[Diarrhea]] (4%) | ||
**Injection site discomfort (2.5%) | **Injection site discomfort (2.5%) | ||
**Depression (2%) | **Depression (2%) | ||
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==See Also== | ==See Also== | ||
[[Anticonvulsants]] | *[[Seizure]] | ||
*[[Anticonvulsants]] | |||
*[[Anticonvulsant levels and reloading]] | |||
== | ==References== | ||
epocrates, medscape | epocrates, medscape | ||
[[Category:Pharmacology]] | [[Category:Pharmacology]] [[Category:Neurology]] | ||
Latest revision as of 15:44, 8 March 2021
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
References
epocrates, medscape