Lacosamide

Uses:

• Used as an adjunctive treatment of partial onset seizures in patients above 17 years of age

How does Lacosamide work?

Lacosamide works slowly by inactivating the sodium-gated channels, which decreases the abnormal and excessive activity of the nerve cells in the brain and controls seizures or fits.

Side Effects of Lacosamide

Common adverse reactions include diplopia, headache, dizziness, and nausea.

Quick Suggestions:

• Take your medication regularly as directed by your doctor as missing doses can trigger seizures.
• Do not change the brand of your medicine and make sure that you have a sufficient amount of medicine present with you.
• Some healthy tips to prevent seizures:
  
  • Practice yoga every day.
  • Get enough sleep at nighttime.
  • Limit the use of screen time such as mobile/laptop.
  • Take your medication on time.
• It may cause dizziness and sleepiness. Do not drive or do anything that requires mental focus until you know how it affects you.
• Talk to your doctor if you notice sudden mood changes or develop suicidal thoughts.
• Talk to your doctor if you have a heart problem that affects your heartbeat.
• Do not stop taking the medication suddenly without talking to your doctor as it may increase the seizure frequency.

Indications:

Lacosamide is prescribed for the treatment of partial-onset seizures in patients aged 4 years and older. However, the safety of Lacosamide injection has not been established in pediatric patients. Lacosamide injection is indicated for the treatment of partial-onset seizures in adult patients aged 17 years and older.

Pharmacology

Lacosamide is believed to provide analgesia by inhibiting sodium channels, primarily affecting depolarized neurons associated with pain and nociceptor hyperexcitability. It also binds to collapsin response mediator protein-2 (CRMP-2), a nervous system phosphoprotein involved in neuronal differentiation and axonal outgrowth. Its role in seizure control is not yet fully understood.

Dosage & Administration of Lacosamide

Adults (17 years and older):

• The initial dosage for monotherapy is 100 mg twice daily.
• The initial dosage for adjunctive therapy is 50 mg twice daily.
• The maximum recommended dosage for both monotherapy and adjunctive therapy is 200 mg twice daily.

Pediatric Patients (4 years to less than 17 years):

• The recommended dosage is based on body weight and is administered orally twice daily.
• Dosage may be increased based on clinical response and tolerability, but no more frequently than once per week.

Injection:

• For intravenous and adult use only when oral administration is temporarily not feasible.
• Administer over 15 to 60 minutes.
• Obtaining an ECG before initiation is recommended in certain patients.

Interaction

Strong CYP3A4 or CYP2C9 Inhibitors: Patients with renal or hepatic impairment taking strong inhibitors of CYP3A4 and CYP2C9 may have increased exposure to Lacosamide, potentially requiring dose reduction.

Concomitant Medications that Prolong PR Interval: Lacosamide should be used with caution in patients taking medications that prolong PR interval, such as beta-blockers and calcium channel blockers, due to the risk of AV block or bradycardia.

Contraindications

None specified.

Pregnancy & Lactation

Based on animal data, Lacosamide may cause fetal harm during pregnancy.

Precautions & Warnings

• Monitor patients for suicidal behavior and ideation.
• Lacosamide may cause dizziness and ataxia.
• Cardiac Rhythm and Conduction Abnormalities: Obtain ECG before and after titration in patients with known cardiac conduction issues or taking drugs known to induce PR interval prolongation.
• Lacosamide may cause syncope.
• Gradually withdraw Lacosamide to minimize the potential for increased seizure frequency.
• Discontinue if Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)/Multi-Organ Hypersensitivity is suspected.
• Use with caution and consider dose adjustment in patients with renal or hepatic impairment.

Storage Conditions

Store at 20°C to 25°C.