- 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.
Therapeutic Indications (from: Australian Product Information Sheets - MIMS)
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.
Common 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 anticonvulsants are potentially teratogenic and this is often dose related (see section: AED Prescribing - Pregnancy)
- For a complete list of adverse effects, appropriate formularies should be consulted.
- Initial dosage as adjunctive therapy if child is < 30kgs: 0.5 – 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.
- Dosages per kilogram can only be used in children of weight approximately up to 30-35kgs.
- Consult appropriate formularies for children with higher weights and in the adult range.
- These dosages are only a guide and appropriate formularies should be consulted as needed and tailored to the patient by the primary physician.
- 50 mg (pink)
- 100 mg (dark yellow)
- 150 mg (salmon)
- 200 mg (blue) film-coated
- 10mg/ 1 ml oral solution
Interactions | 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.
- 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.
- 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.
- 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.
- See section: AED Prescribing - Pregnancy