Lacosamide

Aka: Lacosamide, Vimpat

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II. Indications

  1. Partial-Onset Seizures (adjunctive or monotherapy)

III. Mechanism

  1. Amino Acid based anticonvulsant
    1. Selective promotion of slow inactivation of voltage gated Sodium channels (does not affect fast inactivation)
    2. Stabilizes hyperexcitable Neuron membranes
  2. Also has Analgesic and neuroprotective properties
    1. Binds collapsin response mediator Protein 2 (CRMP2)

IV. Dosing: Adults (age >17 years old)

  1. Partial-Onset Seizure Prophylaxis
    1. Start 50 mg orally or IV over 30 to 60 minutes twice daily
    2. Increase by 50 mg/dose twice daily each week
    3. Target 100 to 200 mg orally twice daily (150 to 200 mg if used as monotherapy)
    4. Maximum: 400 mg/day divided twice daily
      1. Limit to 300 mg/day in hepatic or renal Impairment (Creatinine Clearance<30 ml/min)
      2. Doses of 400 mg/day are as effective as 600 mg/day
  2. Status Epilepticus (Off-Label, non-FDA approved use)
    1. Start 200 to 400 mg IV Load over 5 minutes
    2. May continue at 200 to 600 mg/day divided twice daily oral or IV over 30 to 60 minutes

V. Dosing: Children (age 4 to 17 years old)

  1. Weight 11 to 29 kg
    1. Start 1 mg/kg orally twice daily
    2. Target 3 to 6 mg/kg orally twice daily
  2. Weight 30 to 50 kg
    1. Start 1 mg/kg orally twice daily
    2. Titrate by 1 mg/kg/dose each week, to target 2 to 4 mg/kg orally twice daily
  3. Weight >50 kg
    1. Follow adult dosing

VI. Safety

  1. Unknown Safety in Pregnancy
    1. Fetal toxicity in animals
  2. Unknown Safety in Lactation

VII. Metabolism

  1. Well absorbed from Gastrointestinal Tract without significant impact from food

VIII. Adverse Effects

  1. Well tolerated in the longterm
  2. Common (slow titration of dose reduces side effects)
    1. Dizziness
    2. Ataxia
    3. Blurred Vision
    4. Diplopia
    5. Nystagmus
    6. Headache
    7. Nausea or Vomiting
    8. Tremor
  3. Serious
    1. Slow cardiac conduction (e.g. first degree AV Block)
      1. Significant cardiotoxicity is rare
    2. DRESS Syndrome

IX. Drug Interactions

  1. Few interactions

X. Resources

  1. Lacosamide (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9e79b42c-38a3-4b2c-a196-a5a1948250e2

XI. References

  1. (2022) Presc Lett, Resource #361206, Antiseizure Medications
  2. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 56-7
  3. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Cost: Medications

lacosamide (on 10/18/2023 at Medicaid.Gov Survey of pharmacy drug pricing)
LACOSAMIDE 10 MG/ML SOLUTION Generic $0.17 per ml
LACOSAMIDE 100 MG TABLET Generic $0.29 each
LACOSAMIDE 150 MG TABLET Generic $0.41 each
LACOSAMIDE 200 MG TABLET Generic $0.42 each
LACOSAMIDE 200 MG/20 ML CUP Generic $0.12 per ml
LACOSAMIDE 50 MG TABLET Generic $0.20 each
vimpat (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
VIMPAT 10 MG/ML SOLUTION Generic $0.17 per ml
VIMPAT 100 MG TABLET Generic $0.29 each
VIMPAT 150 MG TABLET Generic $0.41 each
VIMPAT 200 MG TABLET Generic $0.42 each
VIMPAT 50 MG TABLET Generic $0.20 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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