Lacosamide ER

MOTPOLY XR

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FDA label

FDA dosing	Population	Start	Target	Max
Partial-onset seizures (monotherapy)	Adults (17 yr and older)	200 mg QD	300-400 mg QD	400 mg QD
Partial-onset seizures (adjunctive)	Adults (17 yr and older)	100 mg QD	200-400 mg QD	400 mg QD
Primary generalized tonic-clonic seizures (adjunctive)	Adults (17 yr and older)	100 mg QD	200-400 mg QD	400 mg QD
Partial-onset seizures / adjunctive PGTC	Pediatric weighing >=50 kg	100 mg QD	300-400 mg QD (monotherapy) / 200-400 mg QD (adjunctive)	400 mg QD

Titration Increase by 100 mg QD no more frequently than once per week

Renal No adjustment for mild-moderate; severe (CrCl <30) or ESRD: max 300 mg QD; supplement up to 50% after hemodialysis

Hepatic Mild-moderate: max 300 mg QD; not recommended in severe hepatic impairment

Instructions

Swallow capsules whole with liquid; do not open, chew, or crush
May be taken with or without food
On discontinuation, withdraw gradually over at least 1 week

Cautions

Suicidal behavior and ideation
Dizziness and ataxia
Cardiac rhythm and conduction abnormalities (PR prolongation, AV block, ventricular tachyarrhythmia); obtain ECG in patients with proarrhythmic conditions
Atrial fibrillation/flutter
Syncope
Withdraw gradually to minimize increased seizure frequency
DRESS/multi-organ hypersensitivity

Adverse reactions

Diplopia
Headache
Dizziness
Nausea
Somnolence
Vomiting
Fatigue
Ataxia
Tremor

Pregnancy Available human data insufficient to identify drug-associated risk; animal data show developmental toxicity. Pregnancy exposure registry (NAAED) available.

Lactation Lacosamide present in human milk; reports of increased sleepiness in breastfed infants - monitor for excess sedation.

NO BOXED WARNINGS