Brand and Other Names:Vimpat
- Classes: Anticonvulsants, Other
Dosing & Uses
Dosage Forms & Strengths
tablet: Schedule V
injectable solution: Schedule V
oral solution: Schedule V
Partial Onset Seizures
Indicated as monotherapy or adjunctive therapy for partial onset seizures
- 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
- 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
Coadministration with strong CYP3A4 or CYP2C9 inhibitors: Lacosamide systemic exposure may increase; consider dose reduction
- Severe (CrCl <30 mL/min): Not to exceed 300 mg/day
- Hemodialysis: Supplement with up to 50% of dose after dialysis
- Mild to moderate: Not to exceed 300 mg/day
- Severe: Not recommended
IV administration indicated as short-term replacement when PO administration is not feasible
Oral: May take with or without food
<17 years: Safety and efficacy not established
Serious - Use Alternative
Significant - Monitor Closely
Blurred vision (8%)
Balance disorder (4%)
Injection site discomfort (2.5%)
Memory impairment (2%)
Increased ALT (1%)
Local irritation (1%)
Blood and lymphatic system disorders: Agranulocytosis
Cardiac disorders: Bradycardia
Psychiatric disorders: Aggression, agitation, hallucination, insomnia, psychotic disorder
Skin and subcutaneous tissue disorders: Angioedema, rash, urticaria, Stevens-Johnson syndrome, toxic epidermal necrolysis
Increase the risk of suicidal thoughts or behavior; monitor for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior
Dizziness and ataxia reported; may impair ability to perform hazardous tasks
Dose-dependent prolongations in PR interval observed in clinical studies in patients and in healthy volunteers; caution in patients with known conduction problems (eg, marked first-degree AV block, second-degree or higher AV block, and sick sinus syndrome without pacemaker), sodium channelopathies (eg, Brugada Syndrome), on concomitant medications that prolong PR interval, or with severe cardiac disease (eg, myocardial ischemia, heart failure, or structural heart disease)
Increased incidence of syncope in patients with diabetic neuropathy
Oral solution contains aspartame, a source of phenylalanine; 200 mg dose (20 mL) contains 0.32 mg of phenylalanine
One case of multiorgan hypersensitivity reaction reported consisting of symptomatic hepatitis and nephritis
Withdraw gradually over 1 week; do not discontinue abruptly because of risk for increased frequency of seizures
Pregnancy & Lactation
Pregnancy category: C
Lactation: Unknown if distributed in breast milk; use caution
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Antiepileptic effects unknown; may slowly inactivate voltage-gated Na channels
Binds to collapsin response mediator protein-2 (CRMP-2), a phosphoprotein that is expressed mainly in the nervous system and is involved in neuronal differentiation and control of axonal outgrowth
Peak plasma time: 1-4 hr
Protein bound: <15%
Vd: 0.6 L/kg
Predominantly by CYP isoenzymes 3A4 and 2C9; also 2C19
Major metabolite: O-desmethyl-lacosamide (inactive)
Half-life: 13 hr
Dialyzable: Yes (hemodialysis)
May be administered without dilution or diluted in compatible solutions: 0.9% NaCl, D5W, LR
Infuse IV over 15-60 min; 30 to 60 min preferable, and should be used when a 15 min administration is not required
IV lacosamide may cause bradycardia or AV bock in patients with underlying cardiac disease
Monitor infusion closely patients with known cardiac conduction problems, on concomitant medications that prolong PR interval, or with severe cardiac disease (eg, myocardial ischemia, heart failure)
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