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Lacosamide

    Brands

    DEA Class;  Rx

    Common Brand Names; Horizant

    • GABA Analogs

    Oral and injectable functionalized amino acid anticonvulsant
    Used for partial onset and generalized tonic-clonic seizures
    Clinical study experience of intravenous lacosamide is limited to 5 days of consecutive treatment

    Indicated as monotherapy or adjunctive therapy for partial onset seizures

    None

    Tablets and oral solution

    • Dizziness (16-53%)

    • Diplopia (6-16%)

    • Blurred vision (2-16%)

    • Nausea (7-17%)

    • Vomiting (6-16%)

    • Fatigue (7-15%)

    • Ataxia (11-14%)

    • Nystagmus (2-10%)

    IV

    • Fatigue (20-63%)

    • Somnolence (26-34%)

    • Headache (4-16%)

    • Diplopia (4-20%)

    • Nausea (14-24%)

    • Dry mouth (6-12%)

    • Vomiting (4-12%)

    • Fatigue (12-18%)

    • Chest pain (3-12%)

    Increase the risk of suicidal thoughts or behavior; monitor for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior

    Dizziness and ataxia reported; may impair ability to perform hazardous tasks

    Blurred vision and diplopia may occur during therapy; consider increased monitoring in patients with preexisting ocular conditions or vision-related issues

    Oral solution contains aspartame, a source of phenylalanine; 200 mg dose (20 mL) contains 0.32 mg of phenylalanine

    Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), also known as multi-organ hypersensitivity, reported with antiepileptic drugs; some of these events have been fatal or life- threatening; monitor for signs and symptoms of possible disparate manifestations associated with lymphatic hepatic, renal, and/or hematologic organ systems; may require gradual discontinuation and conversion to alternate therapy

    Use caution in renal and hepatic impairment; dosage adjustments may be required

    Withdraw gradually over 1 week; do not discontinue abruptly because of risk for increased frequency of seizures

    There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antiepileptic drugs (AEDs)

    Data from published literature indicate that lacosamide is present in human milk; there are reports of increased sleepiness in breastfed infants exposed to lacosamide; there is no information on effects of lacosamide on milk production

    Adults

    400 mg/day PO or IV.

    Geriatric

    400 mg/day PO or IV.

    Adolescents

    17 years: 400 mg/day PO or IV.
    13 to 16 years weighing 50 kg or more: 400 mg/day PO or IV.
    13 to 16 years weighing 30 to 49 kg: 8 mg/kg/day PO or IV.
    13 to 16 years weighing 11 to 29 kg: 12 mg/kg/day PO or IV.

    Children

    weighing 50 kg or more: 400 mg/day PO or IV.
    weighing 30 to 49 kg: 8 mg/kg/day PO or IV.
    weighing 6 to 29 kg: 12 mg/kg/day PO or IV.

    Infants

    weighing 6 to 29 kg: 12 mg/kg/day PO or IV.
    weighing less than 6 kg: 15 mg/kg/day PO or IV.

    Neonates

    Safety and efficacy have not been established.

    Lacosamide

    tablet: Schedule V

    • 50mg
    • 100mg
    • 150mg
    • 200mg

    injectable solution: Schedule V

    • 200mg/20mL

    oral solution: Schedule V

    • 10mg/mL