Lacosamide
VIMPAT
What it isEnhancer of slow sodium channel inactivation; focal seizures.
Why this oneA mechanism distinct from the fast-inactivation blockers, so it adds where they have failed, with few interactions and an IV form.
What limits itPR interval prolongation, so caution with AV block. Dizziness and diplopia are dose-limiting; Schedule V.
FDA-approved for
- seizures (2008)
Off-label
- neuropathic pain
- status epilepticus
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Partial-onset seizures — monotherapy | adult (≥17 yr) | 100 mg BID | 200 mg BID | |
| Partial-onset seizures — adjunctive; primary generalized tonic-clonic (≥4 yr) | adult (≥17 yr) | 50 mg BID | 200 mg BID | |
| Partial-onset / PGTC seizures | pediatric 1 month to <17 yr | weight-based, twice daily (per Table 1) |
Titration Increase based on response/tolerability no more frequently than once per week
Renal Severe renal impairment (CLCR <30 mL/min) or ESRD: reduce maximum dosage by 25%
Hepatic Mild-to-moderate hepatic impairment: reduce maximum dosage by 25%; severe hepatic impairment: not recommended
Instructions
- Swallow tablets whole with liquid; do not divide; may take with or without food
- Withdraw gradually over at least 1 week when discontinuing
Cautions
- Suicidal behavior and ideation
- Dizziness and ataxia
- Cardiac rhythm and conduction abnormalities (obtain ECG in at-risk patients)
- Syncope
- Withdrawal seizures on abrupt discontinuation
- DRESS/multiorgan hypersensitivity
Adverse reactions
- Diplopia
- Headache
- Dizziness
- Nausea
- Somnolence
Pregnancy Based on animal data, may cause fetal harm; human data insufficient
Lactation Present in human milk; monitor breastfed infants for excess sedation
NO BOXED WARNINGS
Principal riskPR prolongation and dizziness
Cost, est. cash$200–$1,200/month
Generic entry2022
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySedation, dizziness and agent-specific rash, behavioral, hepatic, hematologic or teratogenic toxicity.
Mechanism of action: Lacosamide ballicule
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Memory aids: mascots and interaction avatars
