Adult Dosing
Adjunctive therapy of partial-onset seizures
- Initial dose: Start 50 mg IV q12 hrs
- Maintenance dose: Increase by 100 mg/day qwk up to a maintenance dose of 200 to 400 mg/day, based on individual response and tolerability
Notes- Administer IV over a period of 30-60 mins without further dilution
- While switching from oral to IV and vice versa, initial frequency and total daily dose of IV route should be equal to the frequency and total daily dose of oral route
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- Mild to moderate impairment: No dose adjustments
- Severe impairment (CrCl < 30 mL/min): Max 300 mg/day
- ESRD: Max 300 mg/day
- Hemodialysis: Give 50% of usual dose as supplement following a 4-hour dialysis treatment
- Notes: Caution advised while titration in all renal impaired patients
Hepatic Dose Adjustment
- Mild to moderate impairment: Caution advised while titration; Max 300 mg/day
- Severe impairment: Use not recommended
See Supplemental Patient Information
- Increased risk of suicidal thoughts or behavior; monitor for emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior
- Lacosamide causes dizziness and ataxia; advise patients not to drive or operate complex machinery
- Dose-dependent PR interval prolongation has occurred; increased risk with concomitant PR prolonging drugs/agents. Use with caution in patients with cardiac conduction disorders
- In patients with diabetic neuropathy, asymptomatic first-degree AV block, atrial fibrillation, and atrial flutter have occurred
- Syncope has been reported in patients with diabetic neuropathy who were treated with doses > 400 mg/day
- Withdraw gradually over a period of 1 wk to minimize the risk of increased seizure frequency
- Multiorgan hypersensitivity reactions may occur, suspecting a reaction, drug should be discontinued and alternative treatment should be started
- Monitor Cr at baseline; ECG at baseline if conduction abnormalities or severe cardiac disease, then at steady state
- Monitor for symptoms/signs suggestive of depression, behavior changes, suicidality
Cautions: Use cautiously in
- Severe renal impairment
- Mild to moderate hepatic impairment
- Cardiac conduction disorders (second degree AV block)
- Concurrent PR prolonging agents
- Severe cardiac disease (MI or CHF)
- Hx of suicidal ideation or suicide attempt
- Hx of depression
- Diabetic neuropathy
- Geriatric population
Supplemental Patient Information
- Advise patients to contact physician if symptoms of atrial fibrillation and flutter like palpitations, rapid pulse, shortness of breath occur
Pregnancy Category:C
Breastfeeding: Safety unknown; is excreted in breastmilk of lactating rats. Manufacturer recommends discontinuation of breastfeeding, or discontinuation of treatment (taking into account the importance of the drug to the mother).
17 yrs
