Lacosamide

Usage

  • Lacosamide is a prescription medicine that is used with other medicines to treat partial-onset seizures in children with epilepsy.
  • The PBS indication is for intractable partial seizures not controlled by other anti-convulsants, including first-line medications. Refer to PBS for specific requirements.
  • Its mechanism of action is slow inactivation of voltage gated sodium channels.
  • It does not have significant drug interactions and has a relatively good safety profile.

Resources

Side effects

Common side effects

  • Dizziness, blurred vision, drowsiness.

Other notable side effects

  • Less commonly: irritability, tics, mood change, depression, palpitations, irregular heartbeat, nausea, vomiting and cognitive difficulties.
  • Rarely: Hypersensitivity syndrome, facial oedema.
  • All anticonvulsants are potentially teratogenic and this is often dose related (see section: AED Prescribing - Pregnancy)
  • For a complete list of adverse effects, appropriate formularies should be consulted.

Dosing

  • Initial dose: 0.5 – 1 mg/kg/day for one week and increase weekly by 1mg/kg/day to 2 – 8 mg/kg/day (for children < 40kgs). Dosage is BD.
  • A recommended maintenance dose for adults is 200 to 400 mg / day based on efficacy and tolerability.
  • Oral Lacosamide may be taken with or without food.
  • There is an intravenous preparation. Lacosamide can be used in status epilepsy. For information on intravenous use, consult appropriate formularies and product information.
  • Dosages per kilogram can only be used in children of weight approximately up to 30-40kgs. Consult appropriate formularies for higher weights and in the adult range.
  • These dosages are only a guideline and appropriate formularies should be consulted as needed. 

Preparations:

Tablets

  • 50 mg (pink)
  • 100 mg (dark yellow)
  • 150 mg (salmon)
  • 200 mg (blue) film-coated

Syrup

  • 10mg/ 1 ml oral solution

Intravenous

  • 200mg/20mls

Interactions | Precautions

Precautions

  • Hepatic impairment: Lacosamide’s use is not recommended in patients with severe hepatic impairment.
  • Patients with hepatic impairment who are taking strong inhibitors of CYP3A4 and CYP2C9 may have a significant increase in exposure to Lacosamide.
  • Dose reduction may be necessary in these patients. 

Weaning

  • When ceasing Lacosamide it is important to withdraw slowly (over a minimum of 1 week) to minimize the potential of increased seizure frequency in patients with seizure disorders.

Cardiac

  • Lacosamide may cause prolongation of the PR interval, this is dose related, so monitoring of PR interval may be necessary.
  • Other sodium channel drugs should be avoided e.g. carbamazepine or dilantin.
  • There must be caution if there is a history of cardiac disease or conduction problems.

Pregnancy

  • Usage in pregnancy needs to be discussed with a neurologist.
  • There is limited data on Lacosamide in pregnancy; theoretically it may interfere with CNS development of the foetus.
  • See section: AED Prescribing - Pregnancy