lacosamide
la-koe-sa-myde (Vimpat)
Do not confuse lacosamide with zonisamide, or Vimpat with Venofer, Vfend, or Vimovo.
Monotherapy or adjunctive therapy for treatment of partial-onset seizures in pts 4 yrs and older. Adjunctive therapy in treatment of primary generalized tonic-clonic seizures in adult pts 4 years of age and older.
Contraindications: Hypersensitivity to lacosamide. Cautions: Renal/hepatic impairment, cardiac conduction problems (e.g., marked first-degree AV block, second-degree or higher AV block, sick sinus syndrome without pacemaker), myocardial ischemia, HF, pts at risk of suicide.
Selectively enhances slow inactivation of sodium channels, stabilizing hyper-excitable neuronal membranes and inhibits neuronal firing. Therapeutic Effect: Reduces seizure frequency.
Widely distributed. Protein binding: 15%. Peak plasma concentration: 1—4 hrs after oral dosing and is reached at the end of IV infusion. Primarily excreted in urine. Steady-state reached in 3 days. Removed by hemodialysis. Half-life: 13 hrs.
Pregnancy/Lactation: Use in pregnancy if benefits outweigh risk. Unknown if distributed in breast milk. Children: Safety and efficacy not established in pts younger than 17 yrs. Elderly: No age-related precautions noted.
DRUG: None significant. HERBAL: None significant. FOOD: None known. LAB VALUES: May increase serum ALT; proteinuria.
IVNote: IV dose is same as oral dose. May give undiluted or mixed in compatible diluent and infused over 30–60 min.
PO/IV: ADULTS, ELDERLY: Initially, 50–100 mg twice daily. May increase by 50 mg twice daily at wkly intervals. Maintenance: 150–200 mg twice daily. CHILDREN 4–17 YRS, WEIGHING 50 KG OR MORE: Initially, 50 mg twice daily. May increase by 50 mg twice daily at wkly intervals. Maintenance: 150–200 mg twice daily. WEIGHING 30–49 KG: Initially, 1 mg/kg/dose twice daily. May increase by 1 mg/kg/dose twice daily at wkly intervals. Maintenance: 2–4 mg/kg/dose twice daily. WEIGHING 11–29 KG: Initially, 1 mg/kg/dose twice daily. May increase by 1 mg/kg/dose twice daily at wkly intervals. Maintenance: 3–6 mg/kg/dose twice daily.
PO/IV: ADULTS, ELDERLY: Initially, 50 mg twice daily. May increase by 50 mg twice daily at wkly intervals. Maintenance: 100–200 mg twice daily. Maximum: 400–600 mg/day. CHILDREN 4–17 YRS, WEIGHING 50 KG OR MORE: Initially, 50 mg twice daily. Maintenance: 100–200 mg twice daily. WEIGHING 30–49 KG: Initially, 1 mg/kg/dose twice daily. Maintenance: 2–4 mg/kg/dose twice daily. WEIGHING 11–29 KG: Initially, 1 mg/kg/dose twice daily. Maintenance: 3–6 mg/kg/dose twice daily.
PO/IV: ADULTS, ELDERLY, ADOLESCENTS 17 YRS OF AGE OR OLDER: Initially, 50 mg twice daily. May increase at wkly intervals by 50 mg twice daily. Alternatively, may give 200 mg loading dose, followed 12 hrs later by 100 mg twice daily with same titration schedule. Maintenance: 100–200 mg twice daily. CHILDREN 4–16 YRS: (50 KG OR GREATER): Initially, 50 mg twice daily. May increase at wkly intervals of 50 mg twice daily. Maintenance: 100–200 mg twice daily. (30–49 KG): Initially, 1 mg/kg/dose twice daily. May increase at wkly intervals by 1 mg/kg/dose twice daily. Maintenance: 2–4 mg/kg/dose twice daily. (11–29 KG): Initially, 1 mg/kg/dose twice daily; may be increased at wkly intervals by 1 mg/kg/dose twice daily. Maintenance: 3–6 mg/kg/dose twice daily.
When switching from IV to PO form, use same equivalent daily dosage and frequency as IV administration.
When switching from PO to IV form, initial total daily IV dosage should be equivalent to total daily dosage and frequency of PO form and should be infused IV over 30–60 min.
Use caution when titrating. Mild to moderate impairment: No dose adjustment. Severe impairment, end-stage renal disease: Maximum: 300 mg/day.
Use caution when titrating. Mild to moderate impairment: Maximum: 300 mg/day. Severe impairment: Not recommended.
Frequent (31%–13%): Dizziness, headache. Occasional (11%–5%): Nausea, double vision, vomiting, fatigue, blurred vision, ataxia, tremor, nystagmus. Rare (4%–2%): Vertigo, diarrhea, gait disturbances, memory impairment, depression, pruritus, injection site discomfort.
May increase risk of suicidal ideation, behavior. PR interval prolongation, AV block, ventricular tachyarrhythmias may occur. Sudden discontinuation may increase risk of seizures. Drug reaction with eosinophilia and systemic symptoms (DRESS), also known as multiorgan hypersensitivity, has been reported. DRESS may present with facial swelling, eosinophilia, fever, lymphadenopathy, rash, which may be associated with other organ systems, such as hepatitis, hematologic abnormalities, myocarditis, nephritis. Psychiatric conditions (aggression, agitation, hallucinations, psychotic disorder) may occur. Leukopenia, anemia, thrombocytopenia occur rarely.
