Lacosamide
VIMPAT
Pronunciation: la-KOE-sa-mide (VIM-pat)
“Lacrosse Vampire”
What it isEnhancer of slow sodium-channel inactivation; focal seizures, and adjunct for generalized tonic-clonic seizures.
Why this oneA preferred focal-seizure drug, alone or add-on; distinct mechanism, few interactions, and an IV form.
What limits itPR interval prolongation, so caution with AV block. Dizziness and diplopia are dose-limiting; Schedule V.
Pearls
- Approved for focal seizures from age 1 month
Lacosamide prescription history
Animated chart of estimated U.S. prescriptions per year, Antiseizure meds (1869–2026). Lacosamide enters in 2009 (estimated).
FDA-approved for
- seizures (2008)
Off-label
- neuropathic pain
- status epilepticus
Principal riskPR prolongation and dizziness
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySedation, dizziness and agent-specific rash, behavioral, hepatic, hematologic or teratogenic toxicity.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| 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 seizures (monotherapy or adjunctive) | Peds 1 mo to <17 yr; by weight | ≥50 kg 50 mg BID; 11–<50 kg 1 mg/kg BID; <11 kg 1 mg/kg BID oral (IV <6 kg: 0.66 mg/kg TID) | ≥50 kg 150–200 mg BID mono / 100–200 mg BID adjunctive; 30–<50 kg 2–4 mg/kg BID; 11–<30 kg 3–6 mg/kg BID; <11 kg 3.75–7.5 mg/kg BID oral (IV <6 kg: 2.5–5 mg/kg TID) | Undefined (do not exceed Table 1 titration increments) |
| Primary generalized tonic-clonic seizures — adjunctive | Peds 4 to <17 yr; by weight (≥11 kg bands) | ≥50 kg 50 mg BID; 11–<50 kg 1 mg/kg BID | ≥50 kg 100–200 mg BID; 30–<50 kg 2–4 mg/kg BID; 11–<30 kg 3–6 mg/kg BID | Undefined (do not exceed Table 1 titration increments) |
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; tablets/oral solution with or without food
- Oral solution: use calibrated measuring device (not household spoon); may give via NG/gastrostomy tube
- Injection only when oral temporarily not feasible; same doses as oral if ≥6 kg (<6 kg: TID IV regimen); undiluted or in NS, D5W or LR; infuse over 30–60 min (as rapid as 15 min in adults if required; <30 min generally not recommended in peds)
- IV: ECG before and after titration to steady state if proarrhythmic conditions or conduction-affecting drugs
- Withdraw gradually over at least 1 week when discontinuing
Available strengths
- tab 50, 100, 150, 200 mg
- ER cap 100, 150, 200 mg
- sol 10 mg/mL
- inj 10 mg/mL
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
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 50 mg | tab | 60 BID | $7.12 | not offered |
| 100 mg | tab | 60 BID | $10.46 | not offered |
| 150 mg | tab | 60 BID | $13.28 | not offered |
| 200 mg | tab | 60 BID | $14.88 | not offered |
Other forms: Lacosamide ER (MOTPOLY XR)
Generic entry2022
Open Lacosamide in the interactive console ↗
Memory aids: interaction avatars
Open Lacosamide in the interactive console ↗
Self-check
- Does lacosamide enhance fast or slow sodium-channel inactivation?
Slow. - Which ECG interval can lacosamide prolong?
PR.