We need you! Join our contributor community and become a WikEM editor through our open and transparent promotion process.
Lacosamide
From WikEM
Contents
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
