Lacosamide | Epilepsy clinician handbook
Lacosamide is used to treat partial seizures in children aged 4-16 years.
It is also used in the treatment of primary generalised seizures with idiopathic generalised epilepsy aged 4 years and older.
The PBS indication is for intractable partial seizures not controlled by other anti-convulsants, including first-line medications, in children aged 4-16 years.
The PBS indication for primary generalised tonic-clonic seizures in patients with idiopathic generalised epilepsy is as add-on therapy for children aged 4 years and older. In both PBS indications there are treatment criteria that must be met (see PBS link below).
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.
Important: Dosing information
Initiation and escalation doses on this webpage are a guide only.
All medications must be individualised based on:
- patient age, weight, co-morbidities
- disease, seizure type, frequency, duration
- medication metabolism, interactions, side-effect profile characteristics.
Further consultation with appropriate formularies or a paediatric neurologist may be required.
Dosing
Commonly used regime
- Initial dosage as adjunctive therapy if child is < 30kgs: 1mg/kg/day for one week and increase weekly/fortnightly by 1mg/kg/day to 2 – 6 mg/kg/day, in 2 divided doses.
- For adjunctive treatment in a child 30-50kgs: a common recommended maintenance dose is 4mg/kg/day, in 2 divided doses.
- 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.
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
Therapeutic indications
Australian Product Information Sheets
Vimpat (lacosamide) tablets and oral solution are indicated as:
- monotherapy in the treatment of partial-onset seizures with or without secondary generalisation in patients with epilepsy aged 16 years and older;
- add-on therapy in the treatment of partial-onset seizures with or without secondary generalisation in patients with epilepsy aged 4 years and older;
- add-on therapy in the treatment of primary generalised tonic-clonic seizures in patients with idiopathic generalised epilepsy aged 4 years and older.
Formulary
Possible 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 anti-seizure medications are potentially teratogenic and this is often dose related.
- For a complete list of adverse effects, appropriate formularies should be consulted.
Interactions and 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.
Resources
This information is reviewed annually by the Sydney Children’s Hospitals Network Paediatric Epilepsy NSW working group which includes medical, nursing, and pharmacy representation.