Lacosamide

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
Also has Analgesic and neuroprotective properties
1. Binds collapsin response mediator Protein 2 (CRMP2)

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
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

Weight 11 to 29 kg
1. Start 1 mg/kg orally twice daily
2. Target 3 to 6 mg/kg orally twice daily
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
Weight >50 kg
1. Follow adult dosing

Well tolerated in the longterm
Common (slow titration of dose reduces side effects)
Serious
1. Slow cardiac conduction (e.g. first degree AV Block)
  1. Significant cardiotoxicity is rare
2. DRESS Syndrome