Lacosamidum

Description
Other antiepileptic drugs; lacosamide (R-2-acetamido-N-benzyl-3-methoxypropionamide) is a functionalized amino acid. The precise mechanism of lacosamide’s antiepileptic effect remains unclear.
Indications
Used as an adjunctive therapy to treat partial-onset seizures with secondary generalization or without it in patients aged 16 and older with epilepsy.
Contraindications
Hypersensitivity to the active substance or any excipient. In the presence of second or third-degree atrioventricular (AV) block.
Dosage
For adults. Oral administration. Take 2 tablets/day. The recommended initial dose is 50 mg 2 tablets/day, which should be increased to the initial therapeutic dose of 100 mg 2 tablets/day after a week. The maintenance dose can then be increased by 50 mg 2 tablets/day weekly up to the maximum recommended daily dose of 400 mg (200 mg 2 tablets/day). Take with or without food. Taper off gradually.
For children. Not recommended for children and adolescents under 16 years old due to lack of safety and efficacy data in this age group. For elderly patients. No need to reduce the dose.
Renal impairment. No dose adjustment is needed for patients with mild to moderate renal impairment (CrCl >30 ml/min). For patients with severely impaired renal function (CrCl ≤30 ml/min) and patients with end-stage renal disease, the maximum recommended dose is 250 mg per day. Administer with caution.
Hepatic impairment. No dose adjustment is required for patients with mild to moderate hepatic impairment. Titrate with caution considering existing renal impairment. The pharmacokinetics have not been studied in patients with severely impaired hepatic function.
Adverse reactions
Most common: dizziness and/or headache, nausea, blurred vision.
Other: depression, confusion; disorders of the nervous system; blurred vision; vomiting, constipation, abdominal distension, dyspepsia, dry mouth; itching, rash, muscle spasms; gait disturbance, weakness, fatigue, irritability; collapse; skin lacerations.
Pregnancy
Lacosamide should not be used during pregnancy, except in clearly necessary cases (if the benefit to the mother clearly outweighs the potential risk to the fetus). Additionally, epilepsy treatment should not be discontinued as worsening of the disease is harmful to both the mother and the fetus.
Breastfeeding
For caution, breastfeeding should be discontinued during treatment.
Warnings
Dizziness may occur when treating with lacosamide, leading patients to accidentally injure themselves or fall more often. Patients should be advised to be cautious. Lacosamide should be used with caution in patients with conduction disturbances or severe heart disease, e.g., history of MI or heart failure. Elderly patients should be treated with caution as they may have a higher risk of cardiac disturbances. Use lacosamide cautiously with drugs that prolong the PR interval. Patients should be monitored for signs of suicidal thoughts and behaviors, and appropriate treatment should be considered. Patients (and their caregivers) should be advised to seek medical advice if signs of suicidal thoughts or behaviors occur. Use with caution with potent enzyme inducers (e.g., rifampicin or St. John’s Wort (Hypericum perforatum), carbamazepine, phenytoin, phenobarbital) at various doses.

Source | Drug Guide | Lithuanian University of Health Sciences | Institute of Physiology and Pharmacology | Doctor of Medical Sciences Rimas Jankūnas, Doctor of Medical Sciences Arvydas Milašius | Clinic of Internal Diseases | Doctor of Medical Sciences Palmira Leišytė