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Lacosamide

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Lacosamide, Vimpat

  • See Also
  1. Seizure Disorder
  • Mechanism
  1. Amino Acid based anticonvulsant
    1. Selective promotion of slow inactivation of voltage gated Sodium channels (does not affect fast inactivation)
    2. Stabilizes hyperexcitable Neuron membranes
  2. Also has Analgesic and neuroprotective properties
    1. Binds collapsin response mediator Protein 2 (CRMP2)
  • Indications
  1. Partial-Onset Seizures (adjunctive or monotherapy)
  • Dosing
  • Adults (age >17 years old)
  1. Partial-Onset Seizure Prophylaxis
    1. Start 50 mg orally or IV over 30 to 60 minutes twice daily
    2. Increase by 50 mg/dose twice daily each week
    3. Target 100 to 200 mg orally twice daily (150 to 200 mg if used as monotherapy)
    4. Maximum: 400 mg/day divided twice daily
      1. Limit to 300 mg/day in hepatic or renal Impairment (Creatinine Clearance<30 ml/min)
      2. Doses of 400 mg/day are as effective as 600 mg/day
  2. Status Epilepticus (Off-Label, non-FDA approved use)
    1. Start 200 to 400 mg IV Load over 5 minutes
    2. May continue at 200 to 600 mg/day divided twice daily oral or IV over 30 to 60 minutes
  • Dosing
  • Children (age 4 to 17 years old)
  1. Weight 11 to 29 kg
    1. Start 1 mg/kg orally twice daily
    2. Target 3 to 6 mg/kg orally twice daily
  2. Weight 30 to 50 kg
    1. Start 1 mg/kg orally twice daily
    2. Titrate by 1 mg/kg/dose each week, to target 2 to 4 mg/kg orally twice daily
  3. Weight >50 kg
    1. Follow adult dosing
  • Safety
  1. Unknown Safety in Pregnancy
    1. Fetal toxicity in animals
  2. Unknown Safety in Lactation
  • Metabolism
  1. Well absorbed from Gastrointestinal Tract without significant impact from food
  • Adverse Effects
  1. Common (slow titration of dose reduces side effects)
    1. Dizziness
    2. Ataxia
    3. Blurred Vision
    4. Diplopia
    5. Nystagmus
    6. Headache
    7. Nausea or Vomiting
    8. Tremor
  2. Serious
    1. Slow cardiac conduction (e.g. first degree AV Block)
    2. DRESS Syndrome
  • Drug Interactions
  1. Few interactions
  • Resources
  1. Lacosamide (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9e79b42c-38a3-4b2c-a196-a5a1948250e2
  • References
  1. (2022) Presc Lett, Resource #361206, Antiseizure Medications
  2. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 56-7
  3. Hamilton (2020) Tarascon Pocket Pharmacopoeia