Lacosamide

General

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

Adult Dosing

• Monotherapy
  • 100 mg PO/IV q12hr initially, THEN, based on response and tolerability, increase dose at weekly intervals by 50 mg PO/IV BID; up to a recommended dose of 150-200 mg BID
  • Alternate loading dose schedule: 200 mg PO/IV as a single dose, followed ~12 hr later by starting 100 mg PO/IV BID x 1 week, THEN increase dose at weekly intervals by 50 mg BID; up to a recommended dose of 150-200 mg BID
  • In patients already taking an antiepileptic drug (AED), maintain lacosamide at recommended maintenance dose of 150-200 mg PO BID for at least 3 days before initiating withdrawal of the previous AED
• Adjunctive therapy
  • Initial: 50 mg PO/IV q12hr
  • Based on response and tolerability, increase dose at weekly intervals by 50 mg PO/IV BID; up to a recommended dose of 100-200 mg BID
• Max 400 mg/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 300 mg/day
  • Hemodialysis: Supplement with up to 50% of dose after dialysis
• Hepatic Dosing
  • Mild to moderate: Not to exceed 300 mg/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